Systems and methods of managing payments including assessing propensity to pay

ABSTRACT

Systems and methods of managing payments for services or products are disclosed. Billing system data is extracted or accessed to provide business intelligence and. Visit charges from multiple billing systems can be aggregated to guarantor accounts within or across multiple billing systems and provide a single statement of charges for a given time period. Accounts are accessible online. Accounts can be linked to delegate management authority of a first guarantor&#39;s account to a second (manager) guarantor. Visit charges for linked accounts are included in the manager guarantor&#39;s statement an online access. Open charges balances can be brokered or transferred to a new asset holder. Pre-determined payment options can be configured by a provider, asset holder, and/or potential asset holder. The pre-determined payment options can include an option for financing a balance. A configurable financing option may enable a guarantor to request terms and receive automatic approval, subject to authorized terms.

RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationNo. 61/924,121, titled SYSTEMS AND METHODS OF MANAGING PAYMENTS, filedJan. 6, 2014, which is hereby incorporated herein by reference in itsentirety.

TECHNICAL FIELD

The present disclosure is related to computer-implemented systems andmethods of managing payments for services or products.

BACKGROUND

Collecting payments for goods and services provided is a criticalfunction of businesses, particularly where it may be necessary orpreferable to bill for services or products subsequent to providing themto a beneficiary (e.g., a customer). Convenience in making payments isof importance to many customers, and the payment experience forremitting payments for billed charges can significantly impact animpression of customers for a business. Computing systems have greatlyimproved capability of businesses to track and manage collection ofpayments. The Internet provides a convenient medium for customers tomake payments. Nevertheless, current billing systems lack functionalityto provide features that would enhance effectiveness of paymentcollections for businesses. Similarly, current billing systems arefragmented and incomplete and lack functionality to provide featuresthat provide a positive customer payment experience, thus producingconfusion and frustration for customers and turning a positiveexperience into an overall negative experience with the business.

SUMMARY

The present disclosure provides embodiments of computer-implementedsystems and methods of managing payments for services or products.Embodiments of the disclosed systems and methods may, for example,enable brokering of charges or balances, configuring financing andpayment options for settling amounts owed, assessing guarantorpropensity to pay, linking of multiple guarantor accounts to a managerguarantor, linking of accounts across multiple billing systems,gathering and deriving business intelligence data, managing andpresenting account data, facilitating dispute resolution, and generatinglongitudinal portrayals of visits, among other things, to, for example,improve a payment experience for a business, a customer, and otherparties involved.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of a payment management system for managingpayments for healthcare services, according to one embodiment.

FIG. 2 is a block diagram of an extraction engine of a paymentmanagement system, according to one embodiment.

FIG. 3 illustrates a graphical user interface of a client inputsubsystem of a payment management system, according to one embodiment.

FIG. 4 is a block diagram of a business intelligence subsystem of apayment management system, according to one embodiment.

FIG. 5A is a block diagram of a scoring subsystem of a paymentmanagement system, according to one embodiment.

FIG. 5B is a block diagram of a scoring subsystem of a paymentmanagement system, according to another embodiment.

FIG. 6A is a flow diagram of a method of generating propensity-to-payscoring data, according to one embodiment.

FIG. 6B is a flow diagram of a method for accounts receivableforecasting, according to one embodiment.

FIG. 7 is a block diagram of a public payment portal subsystem of apayment management system, according to one embodiment.

FIG. 8 is a flow diagram of a method of processing payments, accordingto one embodiment.

FIG. 9 illustrates a graphical user interface of a patient inputsubsystem of a payment management system, according to one embodiment.

FIG. 10 is a block diagram of a private payment portal subsystem of apayment management system, according to one embodiment.

FIG. 11 is a flow diagram of another method of processing payments,according to one embodiment.

FIG. 12 is a flow diagram of a method of registering a guarantor,according to one embodiment.

FIG. 13 is a flow diagram of a method of registering a guarantor,according to another embodiment.

FIG. 14 illustrates a graphical user interface to a private paymentportal subsystem, according to one embodiment.

FIG. 15 is a flow diagram of a method of linking guarantor accounts,according to one embodiment.

FIG. 16 is a flow diagram of a method of unlinking guarantor accounts,according to one embodiment.

FIG. 17 is a graphical user interface to a private payment portalsubsystem, according to another embodiment.

FIG. 18 is a flow diagram of a method for presenting a statement ofcharges, according to one embodiment.

FIG. 19 is a flow diagram of a method of processing payment forhealthcare services, according to one embodiment.

FIG. 20 is a flow diagram of a method of processing payment forhealthcare services, according to another embodiment.

FIG. 21 is a flow diagram of a method of processing payment forhealthcare services, according to another embodiment.

FIG. 22 is a diagram of a financing engine of a payment managementsystem, according to one embodiment.

FIG. 23 is a flow diagram of a method of brokering a balance, accordingto one embodiment.

FIG. 24 is a diagram of a payment management system brokering a balance,according to one embodiment.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Collecting payments for goods and services provided is a criticalfunction of businesses, particularly where it may be necessary orpreferable to bill for services or products subsequent to providing themto a beneficiary (e.g., a customer). Certain industries face particularchallenges in collecting payments. The healthcare industry is anindustry in which billing and payment collection is fragmented and tendsto produce a negative patient experience.

Current healthcare billing systems (sometimes referred to as RevenueCycle Management (RCM) systems) are primarily designed to track claimsand optimize payments by third-party payers (e.g., insurers). As aresult, presently available healthcare billing systems present onlyvertical (period-based) portrayals of data and information.Specifically, the billing systems can tell a healthcare provider howmuch cash was collected this month but cannot tell how much of that cashwas collected on balances created in any specific month prior ascompared to those balances created this month. With only a verticalportrayal, a healthcare provider cannot accurately predict paymentrates, understand vendor performance, set intelligent goals, offerintelligent financing, manage repayment risks, etc.

Presently available healthcare billing systems also are not equipped toelegantly manage patient (or guarantor) account balances.Patients/guarantors are generally confused by statements generated byexisting billing systems. The patient/guarantor interfaces to billingsystems, such as to make online bill payments, are fragmented andincomplete, turning a positive patient care experience into an overallnegative experience with the healthcare provider. As an example,presently available healthcare billing systems do not present aguarantor a single electronic statement that includes all chargesincurred for multiple disparate visits during a single period. Asanother example, a guarantor responsible for multiple different patients(e.g., dependents) generally cannot view an electronic aggregation ofcharges for visits of those different patients, especially over time. Aguarantor also cannot link an account, or assume responsibility for anaccount, of another guarantor (e.g., a spouse) without a tedious paperrequest and approval process.

There is also a lack of flexible financing options for patients to payfor healthcare services. Similarly, there is a lack of flexiblefinancing options for a variety of beneficiaries to pay for encountersproviding goods and/or services, for which the encounter charges arebilled to the beneficiary and/or a guarantor of the beneficiary.

There is also a lack of effective systems and methods for assessing thepropensity of a guarantor to pay for a particular type of goods orservices. For example, the credit scores generated by credit reportingagencies can be poor predictors or indicators of a guarantor'slikelihood of paying for healthcare services. Similar shortcomings existin other industries and markets, including but not limited to dentalservices, legal services, auto repair services, and other goods andservices. Credit reporting agencies are largely dependent on datareported by credit lenders, and are often removed from actualtransaction data in specific verticals like healthcare because fewproviders report payment dynamics to these agencies from actualtransaction data. Thus, their credit scores may be limited to data basedon transactions involving credit and for goods/services that may havenothing to do with a given market (e.g., healthcare services).

The presently disclosed embodiments provide improved payment managementfunctionality for a service (or product) provider, such as a healthcareprovider, and enable an improved billing experience for guarantors ofpayment for charges billed for a visit.

The term “provider” as used herein refers broadly to an entity providinga product or service. A provider may be a single individual (e.g., aphysician) providing a benefit or may be an entire organization (e.g., ahealthcare organization with multiple subsidiaries, facilities,locations, departments). In other words, the term “provider” is notlimited to a single individual. Rather a provider may include a singleindividual or entity, a group of individuals or entities, multiplelocations, subsidiaries, departments (e.g., laboratory, pathology,anesthesiology, etc.), affiliates, and the like.

The term “guarantor” as used herein refers to a person (or entity) thathas assumed primary or at least shared financial responsibility forpayment for an amount owed, such as for a product or for servicesrendered (e.g., healthcare services rendered to a patient), either at avisit or at the time of receipt of such product or service. A guarantormakes or gives a promise, assurance, or pledge relating to financialpayment performance on a financial liability, either on behalf ofhimself/herself or on behalf of another. The guarantor, in someinstances, may also be the beneficiary of the product or service (e.g.,a patient in the case of healthcare services). Another example of aguarantor may be a parent or legal guardian of a minor. Although in someinstances laws or regulations may dictate qualifications for a guarantor(e.g., age requirements, mental capacity), the term herein is not boundto these restrictions.

The term “visit” as used herein refers to an encounter or an instance ofreceipt of services (or a product). For example, some embodiments of thedisclosure are described with reference to healthcare services renderedto a patient, and a visit can be considered a physical visit to ahealthcare provider and receipt of healthcare services rendered duringthat physical visit. However, the disclosed embodiments are not limitedto healthcare. Other examples of visits relate to dental services,vision services, mental health services, legal services, automobileservices (e.g., mechanic, routine maintenance), and other repairservices. An example of a product-related visit may include a purchaseof furniture or appliances. As can be appreciated, a visit or encountermay not necessarily involve physical movement of the beneficiary toanother location, and can include services or products that come to thebeneficiary or that are otherwise performed for or directed to thebenefit of the beneficiary.

The term “self-pay” as used herein refers to any obligation owed by thebeneficiary (and/or a guarantor) to a provider. In the context ofhealthcare, self-pay can include co-pays, balances after insuranceadjudication, deductible amounts, etc. The term “self-pay” is notintended to reflect whether or not a beneficiary/guarantor is insured.Rather, “self-pay” is intended to encompass any obligation properly owedby the beneficiary/guarantor in the normal course of business. In otherwords, a provider may consider self-pay receivables as those balancesdue from patients/guarantors for hospital and physician services as aresult of having no insurance or having a balance due even afterinsurance pays, due to coinsurance, deductibles, or noncovered services.

The presently disclosed embodiments access data (e.g., extract, obtain,collect, receive, or otherwise access data), transform the data, andload the data to generate longitudinal portrayals of the data. Alongitudinal portrayal may be cohort-based, where a cohort is a group ofguarantor accounts (within a billing system), balances, and/or visitsthat share a common origination characteristic (typically a specifictime period when a corresponding initial debt was incurred) and forwhich all transactions affecting the balances (e.g., payments, addedcharges, adjustments, interest, fees) are tracked longitudinally overtime. In other words, a longitudinal portrayal includes all transactionsaffecting the balances of a grouping of accounts as tracked over aperiod of time. The grouping of accounts may include accounts (e.g. oneor more accounts) from independent billing systems and/or balance sheetentities.

The presently disclosed embodiments may collect historical visit dataand/or patient information from or within a billing system (or pluralityof billing systems) and create a standardized extract file layout foreach respective billing system of record for subsequently structuringnecessary information to create relevant products to drive self-payfinancial performance and patient experience. The presently disclosedembodiments may also collect data from other systems, such as from acredit data source, a demographics data source, and systems affiliatedwith the provider and/or billing system (e.g., installment loanplatforms), to supplement the visit data and/or patient information.Each transaction identified in the collected historical data isdate/time stamped so that a longitudinal portrayal can be created of agiven visit from the time the initial visit charge is incurred until thevisit charge is ultimately resolved. The collected data may betransformed and organized using a data table structure that enableslongitudinal views of, for example, guarantor type, service location,service type, guarantor financial class, account status, source ofpayments, insurance information, balance, patient and guarantorrelationships, and cash and non-cash transactions. As a result, alongitudinal view of cash and non-cash transaction dynamics (and otherfinancial performance dynamics) of self-pay balances can be provided.

The disclosed embodiments may use the collected data to provide businessintelligence functionality and/or information. An interactive interfacecan be provided by which a provider can achieve a comprehensive view onthe performance characteristics of the provider's self-pay businesscurrently as well as in a given time period or over varying time spans.The business intelligence functionality of the disclosed embodiments canprovide a consolidated view of multiple locations, affiliates, providerentities (e.g., subsidiaries, departments, and other organizationalgroupings), and the like of a given provider (e.g., multiple hospitalsand clinics, laboratories, pathology, anesthesiology). The businessintelligence can also enable a provider to reliably compare performanceand/or effectiveness of third-party vendors (e.g., accounts receivableservicing vendors, debt collection vendors, and the like) on an equal oranalogous basis to tightly manage vendor performance. The businessintelligence can also enable intelligent forecasts of payor andguarantor cash flows for reserve setting purposes, and enable settingand tracking of goals against such forecasts. Standard reports can bedynamically filtered by hundreds of variables. An ad hoc reporting toolcan generate custom reports designed by the user.

The presently disclosed embodiments can also use extracted data toprovide propensity-to-pay (PTP) scores. A PTP scoring assessment uses aprovider's historical transaction data to help assess likelihood offuture guarantor payments based on the specific historical paymentbehaviors of the guarantor being scored. Presently available scoringsolutions rely heavily and often exclusively on credit data provided bycredit reporting agencies or demographics data provided by thirdparties, and neither of these data elements is highly predictive of agiven guarantor's PTP in a specific market, such as the healthcaremarket. Using the provider's historical transaction data greatlyimproves the predictive capability of the resulting PTP scores. Thescoring can consider present visit data and/or past transaction data ofthe guarantor to the provider. The resulting scoring creates aproprietary, highly predictive score without creating either a “soft” or“hard” hit to the guarantor's file at any one of the three major creditreporting agencies (TransUnion, Equifax or Experian).

The PTP scoring can be “always-on,” such that PTP scores automaticallyupdate, such as at various stages of account aging, when cash andnon-cash transactions occur, and/or in response to triggers. A guarantorwith an account balance may be initially assessed for PTP using providerand third-party data, and any subsequent provider-based credit or debitactivity on the specific account can result in an updated score (e.g.,automatically updating the score). Always-on scoring can enable aprovider to create a tailored guarantor billing experience by groupingguarantors into meaningful customer segments that warrant specificaction and treatment. Always-on scoring can also enable better accountmanagement strategies while accounts are in accounts receivable and canenable better account management strategies for accounts moving to baddebt, inclusive of those accounts recommended for a presumptive charitywrite-off.

The scoring can also occur “on-demand,” or triggered by an event inwhich a balance is owed (e.g., post adjudication of actual visitcharges) or is expected to be owed (e.g., pre-treatment or at the timeof treatment). If the balance is expected to be owed, the triggeringevent may be a provider's estimate of a balance to be owed. If thebalance is actually owed, the event may be a provider's actual charge(s)for the balance owed. Once the on-demand scoring occurs, the always-onfunctionality may enable an on-going perspective of the guarantor inquestion. If the guarantor is new to the provider, the PTP logic may usethe provider's historical payment data for other guarantors, and/orthird-party data. On-demand scoring enables appropriate front-endpayment collection strategies for patient access areas (scheduling,registration, pre-authorization). An interface may be provided that canguide or direct use of the PTP scoring, for example by personnel of theprovider. The interface may enable receiving an estimate of future visitcharges. The interface may present one or more PTP scores based on acurrent open charges balance, an estimate of future charges, or a totalbalance owed by a guarantor.

The scoring functionality can also include a presumptive charity rankordering based on PTP assessment for those guarantors that meet charitypolicy requirements (e.g., requirements specified by the provider orother asset holder) based on third-party demographics data andthird-party scores/attributes. By comparison, rank ordering presumptivecharity-eligible patients using presently available credit scores, suchas are produced purely from credit reporting data or demographics data(and thus not very predictive in any certain industries, such ashealthcare), introduces waste and inefficiency.

The disclosed embodiments may use the extracted data and employ rigorousmatching logic to automatically populate an account of a registeredguarantor with information (and particularly billing information) forvisits of the guarantor and/or associated beneficiaries. The guarantoraccounts and balances can continue to reside on the originating billingsystem, and this billing system may remain the system of record fortransactions posted to these accounts. The disclosed embodiments canpresent, for a given billing period, a single digital statement forcharges for visits during a given billing period (e.g., 30-day period)and for which the guarantor has accepted financial responsibility. Thesingle statement may combine visit data of multiple beneficiaries from aplurality of billing systems of one or more healthcare serviceproviders.

The disclosed embodiments may also enable a guarantor to, for example,“consolidate a household” with another registered guarantor. This meansthat a selected guarantor can be designated as a “managing guarantor” ofan aggregated group of guarantors (e.g., within a household or a nuclearfamily) and can interactively manage and/or pay on any guarantor accountwithin that aggregation of managed guarantor accounts (e.g., set up apayment plan or financing plan, pay a specific balance, etc.). Thelinking is compliant with the Health Insurance Portability andAccountability Act (HIPAA) and allows consolidation of billingmanagement for any number of consenting adults or dependent minors toone singular portrayal of a patient's financial obligations potentiallyspanning multiple billing systems within a given provider, or formultiple providers, and managed by one authorized accounts manager (ormanager guarantor). Account linking is generally very difficultoperationally, highly risky from a HIPAA compliance standpoint, andsometimes impossible (across multiple disparate billing systems) in apaper environment. The disclosed embodiments facilitate electroniccommunications (e.g., requests and acceptances) that enable linkingaccounts in minutes as compared to weeks or months in a paper world.Thus, the single digital statement of a manager guarantor provides avehicle to efficiently manage financial records of allhealthcare-related transactions for one or more providers and for allmembers of, for example, a household. Nevertheless, the managedguarantor remains the responsible financial party for his/her visits andthe managed guarantor can continue to access account information andmake payments on any of his/her specific accounts. The disclosedembodiments may facilitate both guarantors agreeing to theconsolidation, and either guarantor can unilaterally terminate theconsolidation at any time.

The digital statement provides a singular portrayal of new charges aswell as prior charges and transaction history for all linked individuals(patients/guarantors). The digital statement is interactive and dynamic,allowing the guarantor (or manager guarantor) to view as much or aslittle detail as desired. The digital statement provides the managerguarantor complete transparency on an aggregated statement of charges,with filtering/searching capability to view specific patient accountswithin the household for given periods of time and to drill down on anyencounter/visit for detailed articulation of charges, includingphysician, service location, provider revenue code, Current ProceduralTerminology (CPT) code, and corresponding descriptions. The filteredsearches can be downloaded for import to another application orconversion to another format.

In some disclosed embodiments, a guarantor (including a managerguarantor) may be enabled to select and configure a single monthly duedate on which payments will be due to the provider. The digitalstatement provides a clear, concise portrayal of a guarantor's financialobligations in one statement each month presented with ample time (e.g.,21 days) before a chosen payment date. The digital statement can showpending insurance claims still in the adjudication process. The digitalstatement may also provide a mechanism for a guarantor to dispute orchallenge a questionable set of charges for a given visit/encounter.Thus, the disclosed embodiments can provide an avenue to efficientlyflag and resolve disputed charges or raise other issues with theprovider and similarly provide a workflow for the provider to addresscharges disputed or other issues raised by a guarantor.

The disclosed embodiments provide the same functionality for anyguarantor of an account even if the guarantor has delegated accountmanagement rights to another guarantor (e.g., a manager guarantor). Thedisclosed embodiments offer encounter-level payment, adjustment, andinterest tracking.

Upon receiving the digital statement, a guarantor can choose how to makea payment. While a payment can be made at any time, general choices(e.g., payment options) may be presented upon receipt of the digitalstatement, such as the following:

-   -   Pay in full for new visits to potentially earn a prompt-pay        discount, based on choices and/or configured preferences of the        healthcare provider and possibly subject to what is allowed by        the guarantor's insurance plan.    -   Customize a new financing plan to pay a new balance comprising        charges for visits from a current statement period.    -   Accept (e.g., by taking no action or affirmatively accepting)        preset financing terms for a multi-month financing plan at a        pre-established interest rate (e.g., a low or 0.0% interest        rate) as configured by the provider or other asset holder.

At the time of filing of this application, the law distinguishes apayment plan, which is presently defined by law to have a duration offour months or less (and subject to certain additional regulatoryrequirements), from a financing plan, which is presently defined by lawto last longer than four months. As used herein, the term “financingplan” includes any payment plan spanning multiple periods (e.g.,months), whether or not distinguished according to definition under thelaw. A financing plan includes open-ended (e.g., revolving) credit aswell as closed-ended (e.g., a loan) credit.

The payment options enabled by the disclosed embodiments provide avehicle through which a guarantor (or manager guarantor) can obtainreliable open-ended credit for current and future financial obligationsto a provider. Aggregated current and historical charges are presentedto the guarantor (or manager guarantor) for balance management andself-servicing. This information may be presented to a guarantorirrespective of whether management rights have been delegated to amanager guarantor. A guarantor can authorize automated, recurringpayments on accounts or make a one-time payment on an account or groupof accounts. The same functionality may be available to any guarantor,irrespective of management delegation. A set of charges for a givenbilling/statement period (e.g., a set of current open charges) that arenot paid in full may be placed on a preset financing plan or configuredfor a custom financing, such that a payment amount will be automaticallydebited from the guarantor's (or manager guarantor's) selected financialtransaction account and automatically credited to specific accounts onthe provider's billing system(s).

The amount for current open charges (e.g., an open charges balance) foreach statement period's visits can be financed according to a newfinancing plan with unique terms, which may be preset financing terms orfinancing terms selected or configured by the guarantor (subject toconstraints/authorization of the provider). A guarantor may havemultiple financing plans active simultaneously. The disclosedembodiments enable one monthly payment for all open financing plans on aguarantor-configured payment date. The financing option allows aguarantor to create self-configured financing plans, for example, bychoosing a monthly payment amount and subsequently accepting theassociated terms the provider has authorized for the resultingamortization schedule (e.g., minimum payment amount, maximumamortization period, interest rates, etc.). Self-configured financingplans may be configured by the guarantor choosing any one or more of aninterest rate, a payment amount, a period for repayment, and/or otherterms that can be compared to provider-authorized terms and/orassociated with provider-authorized terms that can be accepted by theguarantor.

The payment options enabled by the disclosed embodiments also provide avehicle through which a guarantor can pay off an entire set of newmonthly charges and potentially receive a prompt payment discount orother discount offered by the provider. The disclosed embodiments enableproviders to effectively offer and administer prompt payment discountsas well as other types of discounts.

The disclosed embodiments enable automatic transactions (or transfers offunds) on a configured payment date and using a configured paymentmethod. Payment preferences can be configured by each guarantor,including but not limited to the payment date, a preferred mode ofpayment (e.g., checking account, savings account, credit card, debitcard, Health Savings Account), and/or a preferred payment option (e.g.,pay in full, preset financing terms, custom financing terms). Aguarantor can link one or more financial transaction vehicles of choiceto automatically settle payments on new obligations and historicalfinancings with a balance still due.

The features of the disclosed embodiments provide control and choice forhow a guarantor (or manager guarantor) manages healthcare financialobligations.

The disclosed embodiments may enable provider-level, guarantor-level,and/or visit-level decisioning and/or underwriting such that any visitor set of visits for any patient and/or for any guarantor can bechanneled customized financing terms. The decisioning may includedecisioning rules that define criteria to group guarantors. Thecriteria, as mentioned, may be at a provider-level, a guarantor-level,and/or a visit-level (e.g., provider, guarantor income estimate, balanceamount, insurance carrier, type of treatment, etc.). Providers can alsoenable automated discounts for uninsured patients pursuant to theprovider's policies.

The disclosed embodiments may enable brokering of charges and/orbalances. A balance for a batch of open charges, or an open chargesbalance can be automatically evaluated based on one or more pre-definedevaluation criteria to determine whether the open charges balance shouldbe transferred to a new system of record associated with a new entity.If the one or more pre-defined evaluation criteria are met, thedisclosed embodiments may automatically effectuate electronictransactions to transfer the open charges balance to an entityassociated with the new system of record. More particularly, thedisclosed embodiments may automatically effectuate electronictransactions to transfer title of an accounts receivable asset thatconstitutes some or all rights to collect payment for the open chargesbalance. The disclosed embodiments may track transactions relating tothe open charges balance, including payments to pay the current batch ofopen charges, and this tracking may be separate from the first billingsystem.

The disclosed embodiments may also enable providers or other assetholders to offer guarantors interest-bearing financing plans. Thedisclosed embodiments can track and manage interest. The financing planscan enable a provider to secure incremental payments from guarantors andlower the provider's cost of servicing accounts. The financing plans canease a payment burden on a guarantor by spreading payments over a periodof time (e.g., monthly payments for several months).

The disclosed embodiments can generate automated posting files for theprovider billing system(s) such that proper accounts are credited withpayment and/or assessed interest. Adjustments can be automaticallyapplied at the visit level to ensure any overpayments on interest areapplied to principal or credited back to the guarantor's appropriatefinancial account. For example, the disclosed embodiments may receivefirst visit data tracked in a first billing system, including a chargefor a first visit, and second visit data being tracked in a secondbilling system, including a charge for a second visit. The secondbilling system is independent from the first billing system. Thedisclosed embodiments may communicate a transaction request to a paymentgateway to request the payment gateway process an electronic financialtransaction to obtain payment funds in a payment amount from a payorfinancial institution associated with a payment vehicle, to transfer afirst portion of the payment funds to a payee financial institutionassociated with the first patient billing system, and to transfer asecond portion of the payment funds to a payee financial institutionassociated with the second patient billing system. The disclosedembodiments may also communicate electronic posting files to notify thefirst billing system of transfer of the first portion of the paymentfunds toward payment of the charge for the first visit and to notify thesecond billing system of transfer of the second portion of the paymentfunds toward payment of the charge for the second visit. In this manner,guarantor accounts can be linked across billing systems.

FIG. 1 is a block diagram of a system 100 for managing payments forhealthcare services, according to one embodiment. The system 100 of FIG.1 includes a payment management system 102 configured to interface witha billing data source 116A, a healthcare data source 116B, a credit datasource 116C, a demographics/consumer data source 116N, a payment gateway110, and/or a short message service (SMS) provider 112. The paymentmanagement system 102 may interface the data sources 116A-N over anetwork 115 and/or may access one or more of the data sources 116A-Nlocally on computing devices of the payment management system 102 orstorage directly accessible by the payment management system 102. Forexample, the billing data source 116A is shown in FIG. 1 as accessibleover a network 115 (e.g., in a case of a separate, distinct billingsystem of a provider) and as optionally accessible within the data tierof the payment management system 102 (e.g., in a case of an integratedpayment management system 102 and provider billing system). The system100 may interface with and assist one or more client healthcareproviders (e.g., a provider of healthcare services that is a client ofthe payment management system, sometime referred to as a client provideror more simply as a provider). The system 100 facilitates management bya client healthcare provider of payments by patients (or guarantors ofpatients) for healthcare services rendered to a patient by the clienthealthcare provider. The billing data source 116A and/or healthcare datasource 116B may be a billing system (or a plurality of billing systemsof one or more client healthcare providers). The healthcare data source116B may be a health information system (or a plurality of healthinformation systems of one or more client healthcare providers).

The system 100 utilizes collected data, such as data received (e.g.,obtained, extracted, or otherwise accessed) from the billing data source116A, the healthcare data source 116B, the credit data source 116C,and/or the demographics/consumer data source 116N, to provide paymentmanagement functions for the client healthcare provider and associatedguarantors. The functions provided by the system 100 include, but arenot limited to: providing business intelligence information to theclient healthcare provider, assessing PTP scoring information, brokeringcharges and/or balances to transfer a corresponding accounts receivableasset to a new asset holder, enabling offers of configurable financingand payment terms to beneficiaries and/or guarantors, linking accountsof guarantors across billing systems, and linking accounts of guarantorsto an account of a manager guarantor.

The business intelligence provided by the system 100 may includeinformation to enable a provider to reliably compare performance and/oreffectiveness of third-party vendors (e.g., A/R servicing vendors, debtcollection vendors, and the like) on an equal or sufficiently analogousbasis to tightly manage vendor performance. The business intelligencecan also enable intelligent forecasts of payor and guarantor cash flowsfor reserve setting purposes, and enable setting and tracking of goalsagainst such forecasts. Standard reports can be dynamically filtered byhundreds of variables, including but not limited to facility vs.professional billing, location, balance range, patient/guarantorfinancial class, timer period, etc. An ad hoc reporting tool cangenerate custom reports designed by the user. The generated reports canbe pushed via the provider's email system. Generated reports can also bepulled, for example, through electronic, system-generated subscriptionfunctionality. A client provider viewing a report may be able to drilldown on any reported element to the individual guarantor accounts thatcomprise the reported element and subsequently display additionalaccount-level information on that universe of accounts (e.g.,double-click on a section of a bar graph and see a detailed listing ofall individual accounts that comprise that data set).

The PTP scoring provided by the system 100 may include using a clientprovider's historical transaction data to help assess the likelihood offuture guarantor payments based on the specific historical paymentbehaviors of the guarantor being scored or a like guarantor (e.g.,having similar payment characteristics and/or attributes). The PTPscoring can be “always-on,” such that scores automatically update, suchas at various stages and/or in response to triggers, as describedpreviously. The PTP scoring can also occur “on-demand,” or triggered byan event in which a new balance is owed or is expected to be owed, asdescribed previously.

The system 100 also utilizes extracted data to provide payment and/orcommunication functionality to patients (or other beneficiaries) and/orguarantors of patients. For example, the system 100 provides the abilityfor a patient/guarantor to view account information and provide paymentinformation for healthcare services, and the system 100 interfaces withthe payment gateway 110 for processing the payment. The payment gateway110 may effectuate or otherwise facilitate electronic paymenttransactions between a patient (or guarantor) financial institution 176and a provider (or asset holder) financial institution 178. The system100 can present, for a given billing period, a single statement forvisits during the given billing period for which the guarantor hasaccepted financial responsibility. The single statement may combinevisit data from a plurality of billing systems of one or more clienthealthcare service providers. As another example, the system 100 alsointerfaces with the SMS provider 112 to facilitate communication withthe patient and/or the patient's guarantor.

The system may also interface with the provider's general ledger (G/L)180 to provide communications to reconcile what is posted to theprovider's G/L to individual accounts within the billing system. Forguarantor payments that only involve principle, that reconciliation maybe generally straightforward because the posting files to the billingsystem, which go through that system to the provider's G/L, tie exactlyto the files that go from the payment gateway 110 to the provider G/L interms of money transferred. The complexity increases when a portion ofthe payment is allocated to interest charges, because the billing systemmay not have any ability to deal with the concept of interest. As such,an ‘interest payment’ file can be posted to the provider's G/L to tiethe cash the provider received from the payment gateway 110 (in terms ofmoney transferred to provider's bank 178) to what the provider isshowing in its billing system. Otherwise, it would appear that thebilling system amount (which is principle only in the case of a billingsystem that cannot account for interest) is short (and it is by theamount of interest). If a billing system can handle interest, postingfiles may only be posted to the billing system (and not to theprovider's G/L) because existing reconciliation processes between theprovider's billing system and the provider's G/L are available for bothprinciple and interest. The payment gateway 110 may still post a postingfile to the provider's G/L and that amount can be reconciled solely tothe billing system records.

The system 100 can automate brokering of charges and/or balances. Abatch of open charges of a guarantor (and any linked or managedguarantors) in a given period can be aggregated from the data extractedfrom one or more billing systems to determine an open charges balance.The open charges balance can be automatically evaluated by the system100, based on one or more pre-defined evaluation criteria, to determinewhether the open charges balance should be transferred to a new systemof record associated with a new entity. If the one or more pre-definedevaluation criteria are met, the system 100 may automatically effectuateelectronic transactions to transfer the open charges balance to anentity associated with the new system of record. The system 100 may bethe new system of record.

The system 100 can enable configurable financing and payment terms byallowing a provider to configure pre-set financing terms or authorizedfinancing terms that can be offered to guarantors for an open chargesbalance. The authorized financing terms may allow guarantorconfiguration of a financing plan, while the pre-set financing terms maynot allow guarantor configurability. Further, the system 100 canevaluate the open charges balance to determine an appropriate set ofterms (e.g., pre-set financing terms and/or authorized financing terms)to offer for the open charges balance.

The system 100 can link guarantor accounts to a guarantor who hasaccepted management responsibility. The system 100 can facilitateelectronic communications to obtain any required consent to manageand/or authorization to delegate management authority. Upon appropriateapprovals, the account data of a managed guarantor can be aggregatedwith account data of the manager guarantor.

The system 100 can also link guarantor accounts across billing systems.First visit data originated in a first billing system and second visitdata originated in a second billing system can be aggregated for aguarantor to allow presentation of the guarantor's visit data from bothbilling systems in a singular interactive electronic statement. Thesystem 100 also facilitates payments for the aggregated open chargesbalance, initiating the appropriate financial transactions between payorand payee financial institutions and communicating posting files to thebilling systems to notify of the portion paid toward specific chargesoriginated in each billing system.

The payment management system 102 may implement or otherwise provide oneor more of the foregoing functionality. The payment management system102 of FIG. 1 is structured to include a data tier 120, an applicationtier 140, and a presentation tier 160. The data tier 120 can extract,collect, transform, store, and otherwise manipulate data for use by theapplication tier 140 and/or for presentation by the presentation tier160. The application tier 140 may utilize data of the data tier 120 toprovide payment management functions. The presentation tier 160 maypresent to users of the system, including client healthcare providersand/or patients/guarantors of the client healthcare providers,information and/or an interface to the payment management functionsenabled by the application tier 140.

The data tier 120 may include an extraction engine 122 and one or moredatabases in a datastore 121. The extraction engine 122 may beconfigured to extract data from the billing data source 116A, thehealthcare data source 116B, the credit data source 116C, and/or thedemographics/consumer data source 116N for use by the system 100. Theextraction engine 122 may be configured to simply aggregate or otherwisecollect data tracked in a first billing system of which the paymentmanagement system 102 is a component or of which is integrated into thepayment management system 102. In other words, extraction by theextraction engine may simply be collection or other access of local anddirectly accessible data, and is not limited to retrieving or extractingdata from external or remote data sources. The extraction engine 122 maytranslate, convert, transform, or otherwise structure the extractedand/or collected data and may load the transformed data to the datastore121 and/or to data structures of databases in the datastore 121. Theextraction engine 122 is discussed in greater detail below withreference to FIG. 2.

The application tier 140 may include a business intelligence subsystem142, a scoring subsystem 144, a public payment portal subsystem 146, anda private payment portal subsystem 148. These subsystems leverage dataextracted and/or stored by the data tier 120 to provide paymentmanagement features and functionalities.

The business intelligence subsystem 142 provides business intelligenceinformation and functionality to a client healthcare provider. Thebusiness intelligence subsystem 142 may be configured to generatereporting information pertaining to any aspect of the payment managementsystem 102. The business intelligence subsystem 142 may be furtherconfigured to generate forecasts of accounts receivable activity basedon PTP metrics corresponding to outstanding balances.

The scoring subsystem 144 provides PTP and presumptive charityinformation and functionality to a client healthcare provider. Thescoring subsystem 144 may be configured to assign PTP scores and/orsegmentation or grouping identifiers derived from those PTP scores toaccounts managed by the payment management system 102. The PTP scoresmay incorporate information regarding the transaction history of theaccount guarantor with the healthcare system. PTP scores may alsoincorporate information related to the condition of the patient, creditreporting information, demographics, and/or the like. The scoringsubsystem 144 may be further configured to identify accounts that arecandidates for presumptive charity based on, inter alia, PTP scoringand/or other information indicating that the guarantor is unlikely tohave the ability to pay (e.g., balance history, credit reportinginformation, demographics, and/or the like).

The public payment portal subsystem 146 allows unregistered guarantorsto pay charges for healthcare services. The guarantor may be notified ofthe charges, for example, by a bill or statement mailed in paper format.The public payment portal subsystem 146 enables a client provider tooffer a uniform, single online (or electronic) payment interface,regardless of the client provider billing system in which the chargesfor the healthcare services may be originated, tracked, stored, andotherwise managed. In other words, a client healthcare provider thatutilizes a plurality of billing systems (e.g., due to acquisition ofbusiness units, clinics, hospitals, and the like) can manage payments toany of these plurality of billing systems through the disclosedembodiments. The public payment portal subsystem 146 allows guarantorswho may not be registered for the private payment portal subsystem 148to make payments through the disclosed embodiments.

The private payment portal subsystem 148 enables a registered guarantorto log in and be presented with protected health information (PHI) thatfacilitates payment and account management. Through the private paymentportal subsystem 148, the registered guarantor can view visitinformation to better understand charges for a visit. The registeredguarantor can view an electronic billing statement reflecting chargesfor visits incurred during the statement period. The electronic billingstatement may reflect an aggregation of charges originated at aplurality of different billing systems. The registered guarantor canalso request to have an account managed by another registered guarantoror alternatively request to manage the account of another registeredguarantor. The electronic billing statement of a manager guarantor mayreflect charges of managed guarantors. In some embodiments, a clientprovider may coordinate linking of accounts, such as by sending arequest to a guarantor to take a manager guarantor role and requestinganother guarantor be managed by the manager guarantor.

The presentation tier 160 may include a client input subsystem 162 and aguarantor input subsystem 164. The client input subsystem 162 maypresent or otherwise provide a graphical user interface for a clienthealthcare provider to interface with the system 100. In someembodiments, the graphical user interface may be provided through orotherwise integrated with an interface of a billing system.

The client input subsystem 162 may more particularly interface with thebusiness intelligence subsystem 142 and/or the scoring subsystem 144 toenable a client healthcare provider to view and otherwise access and/ormanipulate business intelligence information provided by the businessintelligence system 142 and/or to access scoring functionality providedby the scoring subsystem 144. An example of a graphical user interfaceof a client input subsystem 162 is shown in FIG. 3 and discussed belowwith reference to the same.

The guarantor input subsystem 164 may present or otherwise provide agraphical user interface for a guarantor to interface with the system100. The guarantor input subsystem 164 may more particularly interfacewith the public payment portal subsystem 146 and/or the private paymentportal subsystem 148 to enable a patient or guarantor to viewstatements, make payments, link to accounts of other guarantors, and thelike. An example of a graphical user interface of a guarantor inputsubsystem 164 is shown in FIG. 9 and discussed below with reference tothe same.

The graphical user interface(s) of the client input subsystem 162 andthe guarantor input subsystem 164 may be provided to a patient/guarantorcomputing device 170, a provider/asset holder computing device 172,and/or other client computing device, such as via a network 115 (e.g.,over the Internet). Described differently, the system 100 may implementa software as a service (SaaS) delivery model in which the paymentmanagement functionality provided by the system 100 and associated dataare accessed over the Internet. However, as can be appreciated, thesystem 100 may be implemented using other appropriate architectures andconfigurations. For example, the disclosed embodiments may be deployeddirectly on or using computing devices of a client provider, forexample, inside the client provider's firewall. As another example, thedisclosed embodiments may be deployed within and/or on a clientprovider's billing system.

Extraction Engine

The extraction engine 122 may be configured to access informationpertaining to particular guarantors, patients, organizations, and/or thelike. As disclosed in further detail herein, the information gathered bythe extraction engine 122 may be used by the payment management system102 to provide improved payment management functionality. The extractionengine 122 may be configured to acquire data from one or more datasources 116A-N. The extraction engine 122 may be configured to accessthe data sources 116A-N by use of the network 115. The network 115 maycomprise any suitable communication infrastructure, including, but notlimited to, a Transmission Control Protocol/Internet Protocol (TCP/IP)network, a Local Area Network (LAN), a Wide Area Network (WAN), aVirtual Private Network (VPN), a Storage Area Network (SAN), and/or thelike.

In other embodiments, the extraction engine 122 may access the one ormore data sources 116A-N directly, such as in local storage. Stateddifferently, the extraction engine 122 may extract data merely byaccessing local data sources or otherwise directly accessible datasources. Extraction is not limited to extracting or otherwise obtainingdata from external or remote data sources.

The billing data sources 116A may include one or more hospital billingsystems, clinic billing systems, practitioner billing systems (e.g.,physician billing systems), and/or the like. The healthcare data sources116B may include, but are not limited to: electronic health recordsystems, Personal Health Record (PHR) systems, Personal HealthInformation Technology (PHIT) systems, Electronic Health Record (EHR)systems, Health Information Exchange (HIE) systems, and/or the like. Thecredit data sources 116C may include credit reporting agencies, such asEquifax, Experian, TransUnion, and/or the like. Thedemographics/consumer data sources 116N may include demographic and/orconsumer profiling data sources configured to provide informationincluding, but not limited to: census information (e.g., date of birth,head of household, marital status, ethnicity, age, education level, andthe like), household information (e.g., phone number, number ofdependents, length of residence, residence status, residence size,residence value, and the like) economic information (e.g., income level,purchasing power, and the like), mortgage information (e.g., mortgageamount, rate, term, and the like), neighborhood information,socio-economic indicators, and so on.

The extraction engine 122 may be configured to access the data sources116A-N in accordance with applicable regulations, which may include, butare not limited to, regulations of the HIPAA, Payment Card Industry DataSecurity Standard (PCI DSS), Sarbanes-Oxley Act (SOX), Fair CreditReporting Act (FCRA), Fair and Accurate Credit Transactions Act (FACTA),self-imposed regulations (e.g., a privacy policy or contract),jurisdictional regulations (e.g., data access regulations of particularstates, countries, and/or regions), and/or the like. The extractionengine 122 may be further configured to access data of the data sources116A-N according to particular data sharing protocols and/or standards.In some embodiments, the extraction engine 122 is configured totransform, convert, and/or translate information acquired from the datasources 116A-N for use by the payment management system 102.

As depicted in FIG. 1, the data tier 120 may comprise the datastore 121configured to manage information used by the modules, subsystems,services, and/or components of the payment management system 102. Thedatastore 121 may comprise any suitable data storage and/or managementsystem including, but not limited to, a database management system(DMBS), a Structured Query Language (SQL) database, an eXtensible MarkupLanguage (XML) database, an object database, a key-value storage system,a file system, a directory (e.g., an X509 directory), and/or the like.The datastore 121 may comprise a schema that defines a data format,structure, and/or arrangement. The extraction engine 122 may beconfigured to transform data acquired and/or derived from the datasources 116A-N in conformance with the database schema, and to transfersuch data into the datastore 121.

FIG. 2 is a block diagram of one embodiment of an extraction engine 122.In the FIG. 2 embodiment, the extraction engine 122 comprises datasource adapters 123A-N, which may be configured to interface withrespective data sources 116A-N. The data source adapter 123A, forexample, may be configured to access one or more billing data sources116A through, for example, a Simple Object Access Protocol (SOAP)interface of the billing data sources 116A, the data source adapter 123Bmay be configured to access one or more healthcare data sources 116Busing Secure File Transfer Protocol (S FTP), and so on. The data sourceadapters 123A-N may be further configured to issue queries to the datasources 116A-N. The queries issued by the data source adapters 123A-Nmay be configured to acquire particular types of information pertainingto particular entities, such as particular guarantors (e.g.,individuals), organizations, accounts, residences, and/or the like. Thedata source adapters 123A-N may be further configured to push data tothe data sources 116A-N (e.g., update the contents of the data sources116A-N with additional credit reporting information, demographicinformation, and/or the like). Although FIG. 2 depicts a plurality ofdata source adapters 123A-N, the disclosure is not limited in thisregard and could be adapted to use a single data source adapter 123A-Nto interface with a plurality of different data sources 116A-N.

The data source adapters 123A-N may be configured to secure datatransferred to/from the data sources 116A-N by, for example,authenticating the data sources 116A-N, providing authenticationcredential(s) to the data sources 116A-N, encrypting data transmittedto/from the data sources 116A-N, signing data transmitted to/from thedata sources 116A-N, and/or the like. In some embodiments, the datasource adapters 123A-N are configured to communicate with the datasources 116A-N by use of respective, mutually authenticated securesockets layer (SSL) connections.

The extraction engine 122 may comprise a data access policy module 223configured to manage data access operations of the data source adapters123A-N. The data access policy module 223 may be configured to: a)ensure compliance with data access restrictions applicable to the datasources 116A-N; b) manage authentication credentials of the data sources116A-N (e.g., credentials used to authenticate the data sources 116A-Nto the extraction engine 122, such as public key certificates,cryptographic signatures, Kerberos tickets, and/or the like); c) manageauthentication credential(s) of the data source adapters 123A-N (e.g.,credentials used to authenticate the data source adapters 123A-N to thedata sources 116A-N, such as private keys, and/or the like); d) maintainauditing information pertaining to operations of the data sourceadapters 123A-N; and e) perform other similar functions. The auditinginformation may be stored in the datastore 121 and/or another storagesystem. Although FIG. 2 depicts a single data access policy module 223,the disclosure is not limited in this regard and could be adapted toinclude a plurality of policy modules 223 (e.g., a separate data accesspolicy module 223 for each data source adapter 123A-N).

The datastore 121 may comprise a directory of entity records 210, whichmay comprise information pertaining to particular patients and/orguarantors of the healthcare system. In some embodiments, the entityrecords 210 include, inter alia, data access rules 211. The data accessrules 211 may specify, inter alia, the types of information the paymentmanagement system 102 is authorized to access for particular entities.For example, a data access rule 211 for an entity may indicate whetherthe payment management system 102 is allowed to access healthcareinformation pertaining to the entity from a healthcare data source 116B.The data access policy module 223 may be configured to manage the dataaccess rules 211 in the datastore 121; the data access policy module 223may be configured to set and/or update data access rules 211 pertainingto particular entities in response to inputs received through one ormore of: a) the client input subsystem 162, b) the guarantor inputsubsystem 164, and/or c) other configuration interface(s). The dataaccess rules 211 may further include preferences regarding privacy, datasharing, and/or the like. The data access rules 211 may be configured toensure compliance with the data access regulations, disclosed above.Accordingly, the data access policy module 223 may be configured tosecure the data access rules 211, such that the data access rules 211are only modified and/or updated in response to authorized requests. Thedata access policy module 223 may, for example, be configured toauthenticate requests to modify the data access rules 211 to ensure thatthe modifications are authorized by the corresponding entity and/orentity guardian.

The data source adapters 123A-N may be configured to request orotherwise access data from the data sources 116A-N in accordance withthe data access rules 211. The data source adapters 123A-N may, forexample, only access healthcare information pertaining to entities thathave authorized such access. The data access rules 211 may be furtherconfigured to limit access to particular types of information. A dataaccess rule 211 may, for example, exclude certain types and/or classesof healthcare information from being accessed by the payment managementsystem 102.

As disclosed above, the data source adapters 123A-N may be configured torequest data from respective data sources 116A-N by, inter alia, issuingrequests for data pertaining to particular entities. The requests may beconfigured to comply with the data access rules 211, disclosed above. Inone embodiment, a data source adapter 123B may be configured to accessspecific healthcare information pertaining to a particular entity from ahealthcare data source 116B. Similarly, a data source adapter 123C maybe configured to acquire credit information pertaining to a particularentity from a credit data source 116C, and/or a data source adapter 123Nmay be configured to acquire specific demographic information pertainingto the particular entity from a demographics/consumer data source 116N.Alternatively, or in addition, one or more of the data source adapters123A-N may be configured to access data in one or more bulk transferoperations. In one embodiment, the data source adapter 123A may beconfigured to perform bulk transfer operations to acquire all of thebilling records for a particular period (e.g., a day) from a billingdata source 116A. In another embodiment, the one or more data sourceadapters 123A-N may be configured to access data of respective datasources 116A-N, and in real time. As an example, the data source adapter123A may access the billing records of a billing data source 116A (e.g.,a billing system and/or records local to, or integrated with, thepayment management system 100 of FIG. 1).

The data source adapters 123A-N may be configured to acquire dataaccording to data sharing protocol(s), format(s), or arrangement(s)supported by the respective data sources 116A-N, which may differ fromthe data protocol(s), format(s), and/or arrangement(s) of the datastore121. The extraction engine 122 may, therefore, comprise datatransformation modules 124A-N configured to transform, convert, and/ortranslate data acquired from the data sources 116A-N for use by thepayment management system 102. The transformation modules 124A-N may beconfigured to parse data structures acquired from the respective datasources 116A-N and to transform the constituent data into a format thatis compatible with the schema of the datastore 121. Although FIG. 2depicts separate transformation modules 124A-N corresponding toparticular data sources 116A-N (and/or data source adapters 123A-N), thedisclosure is not limited in this regard and could be adapted to includea single transformation module configured to transform, convert, and/ortranslate data of a plurality of different data sources 116A-N.

As disclosed above, the extraction engine 122 may be configured toacquire or otherwise access data pertaining to healthcare transactionsfrom one or more billing data sources 116A (by use of data sourceadapters 123A), and to transform the billing information into anormalized data format compatible with the datastore 121. The extractionengine 122 may further include a datastore interface module 125configured to store corresponding records in the datastore 121. Theextraction engine 122 may be configured to store billing transactionrecords 214, which may be configured to track bills issued to aparticular patient and/or guarantor. A billing transaction record 214may include, but is not limited to, a transaction identifier (e.g.,invoice and/or bill identifier), a time stamp (the date and/or timecorresponding to the billing transaction), the payee (e.g., hospital,clinic, service provider, etc.), service(s) provided, service type,service provider(s), service location, patient, patient type, bill type,and/or the like. The extraction engine 122 may be configured toassociate billing transaction records 214 with particular patient(s)and/or guarantor(s). In some embodiments, the extraction engine 122 isconfigured to maintain such associations by use of links and/orreferences to account records 212 and entity records 210.

The bill type may indicate whether the corresponding billing transactionpertains to an amount that is non-adjudicated, adjudicated, self-pay,split balance, payment plan, financing plan, and/or the like. Anon-adjudicated billing transaction record 214 refers to a billingtransaction that may be covered by insurance, but that insuranceadjudication has not yet taken place. A non-adjudicated billingtransaction record 214 may be generated at the time the patient isdischarged, at the time of the visit, and/or the like. An adjudicatedbilling transaction record 214 refers to a billing transaction that hasbeen adjudicated by the insurer. Accordingly, an adjudicated billingtransaction record 214 may include a self-pay amount to be paid by thepatient and/or guarantor associated with the billing transaction record214. A self-pay billing transaction record 214 refers to a portion of abilling transaction that is directed to a patient obligation (e.g. acharge not covered by insurance and/or the self-pay portion of anadjudicated billing transaction). Therefore, like the adjudicatedbilling transaction record 214 above, a self-pay billing transactionrecord 214 indicates a balance that is payable by the patient and/orguarantor associated with the billing transaction record 214. A splitbalance billing transaction record 214 refers to a billing transactionrecord 214 corresponding to a portion of a balance payable by aparticular patient and/or guarantor. A financing plan billingtransaction record 214 refers to a billing transaction associated with afinancing plan (e.g., financing plan record 218), as disclosed infurther detail herein. Although particular bill types are describedherein, the disclosure is not limited in this regard and could beadapted to include any suitable bill type corresponding to any suitablebilling condition, balance type, or the like.

The extraction engine 122 may be configured to acquire informationpertaining to particular patients and/or guarantors (entities) of thepayment management system 102. Such information may include, but is notlimited to, entity identifying information (e.g., name, birthdate,address, contact information, social security number (SSN), and/or thelike), insurance information (health insurance provider, limits,deductibles, co-payments, and/or the like), demographic information(neighborhood, socio-economic characteristics, and/or the like), creditinformation, healthcare-related information, scoring metrics, dataaccess rules 211, and/or the like. The contents of the entity records210 may be aggregated from the data sources 116A-N. An entity record 210may include identifying information acquired from a billing data source116A, credit information from a credit data source 116C, demographicsand consumer information from a demographics/consumer data source 116N,and/or the like. In some embodiments, entity records 210 may furtherinclude healthcare information related to the patient (e.g., patienttype) determined from information in a healthcare billing transactionand/or healthcare data source 116B.

The extraction engine 122 may be further configured to includeinformation pertaining to patient-guarantor relationships. An entityrecord 210 may, for example, identify one or more guarantors. Asdisclosed above, a guarantor refers to an entity that is at leastpartially responsible for healthcare costs of a particular patient. Theentity record 210 of such a patient may identify the guarantor(s) thathave assumed responsibility for healthcare costs of the particularpatient. Similarly, the entity record 210 of a guarantor may identifythe patient(s) for whom the particular entity has assumedresponsibility. In one example, the entity records 210 of a family maybe correlated or otherwise associated, such that entity record(s) 210 ofthe parent(s) and/or guardian(s) of the family reference entityrecord(s) 210 of the dependent(s) of the family (and vice versa).Although examples of familiar patient-guarantor relationships aredescribed herein, the disclosure is not limited in this regard;patient-guarantor relationships can be formed between any consentingadults. Moreover, in some embodiments, a guarantor is not responsiblefor financial obligations; instead, the guarantor may be grantedmanagement rights to coordinate payment for an account.

The patient-guarantor relationships may be determined by use of acorrelation engine 126. The correlation engine 126 may be configured todetermine patient-guarantor relationships by use of information acquiredfrom one or more of the data sources 116A-N, including, but not limitedto, billing transaction information (e.g., a guarantor may be specifiedby the billing data source 116A), healthcare information (e.g.,parent-child relationships) acquired from a healthcare data source 116B,demographic information, and/or the like. Alternatively, or in addition,the correlation engine 126 may be configured to establishpatient-guarantor relationships in response to inputs provided throughone or more of the client input subsystem 162 and/or guarantor inputsubsystem 164, as disclosed in further detail herein.

The patient-guarantor relationships managed by the correlation engine126 may be used to generate respective account records 212. The accountrecords 212 may identify a patient and guarantor(s) (e.g., may be linkedto a patient entity record 210 and guarantor entity record(s) 210). Asdisclosed above, in some instances, the patient and guarantor may be oneand the same (e.g., the patient may be solely responsible for paymentand, as such, may act as his or her own guarantor). Alternatively, aguarantor may be responsible for billing transactions corresponding toone or more other entities (e.g., a parent may act as the guarantor forbilling transactions corresponding to his or her dependents).Accordingly, and as illustrated in FIG. 2, an account record 212 mayreference (and/or be linked to) a plurality of entity records 210.

The extraction engine 122 may be configured to link account records 212to billing transaction records 214 by use of the correlation engine 126.The correlation engine 126 may be configured to associate a billingtransaction record 214 with an account record 212 by a) accessinginformation in the billing transaction record 214 that identifies apatient and/or guarantor (e.g., patient and/or guarantor name, all orportion of an SSN, and/or the like); b) identifying entity record(s) 210corresponding to the patient and/or guarantor in the datastore 121 usingthe identifying information and/or the patient-guarantor relationshipsof the entity records 210; and c) linking the billing transaction record214 with an existing account record 212 corresponding to the accessedentity record(s) 210, or generating a new account record 212 for thebilling transaction record 214.

The extraction engine 122 may be further configured to acquireinformation pertaining to payment transactions from the billing datasources 116A (by use of the data source adapters 123A). In response, theextraction engine 122 may be configured to store a payment transactionrecord 216 in the datastore 121 (by use of a transaction module 124Aand/or datastore interface 125). The payment transaction record 216 mayinclude, but is not limited to, a transaction identifier (e.g., invoiceand/or bill identifier), a payment date, a payment source (e.g., cash,check, credit card, etc.), a payment type (e.g., full payment,co-payment, etc.), payee-identifying information, an indication of wherethe transaction took place (e.g., hospital, clinic, on-line, etc.),and/or the like. The correlation engine 126 may be configured to linkthe payment transaction record 216 to a billing transaction record 214based on, inter alia, the transaction identifier, patient- and/orguarantor-identifying information of the payment transaction record 216,and/or the like. The balance of a billing transaction record 214 may bepaid over a number of different payment transactions; therefore, and asillustrated in FIG. 2, a billing transaction record 214 may reference(and/or be linked to) a plurality of payment transaction records 216.

The transaction information acquired by the extraction engine 122 maycomprise a normalized, longitudinal data set, which may be leveraged byother subsystems of the payment management system 102. Referring to FIG.1, in some embodiments, the business intelligence subsystem 142 in theapplication tier 140 of the payment management system 102 is configuredto generate information and/or metrics pertaining to billing and/orpayment transactions processed by the payment management system 102. Asdisclosed in further detail herein, the business intelligence subsystem142 may be configured to generate interactive reports pertaining to anysuitable aspect and/or metric pertaining to the payment managementsystem 102, including, but not limited to, performance of billingsystems (e.g., time to pay, payment rate); payment metrics filtered bybalance range, demographics, time period, insurance coverage, and/or thelike; user-designed reports; and so on. The interactive reportsgenerated by the business intelligence subsystem 142 may furthercomprise scoring information generated by the scoring subsystem 144.

Client Input Subsystem

FIG. 3 illustrates a graphical user interface 300 of a client inputsubsystem of a payment management system, according to one embodiment.The user interface 300 provides an interactive interface by which aclient provider can achieve a comprehensive view on the performancecharacteristics of the client provider's self-pay business currently, aswell as in a given time period or over varying time spans. The businessintelligence functionality of the disclosed embodiments can provide aconsolidated view of multiple locations of a given client provider(e.g., multiple hospitals and clinics). The business intelligencefunctionality can also enable a client provider to reliably compareperformance and/or effectiveness of third-party vendors (e.g., accountsreceivable servicing vendors, debt collection vendors, and the like) onan equal or analogous basis to tightly manage vendor performance. Thebusiness intelligence functionality can also enable intelligentforecasts of payor and guarantor cash flows for reserve setting purposesand enable setting and tracking of goals against such forecasts.Standard reports can be dynamically filtered by hundreds of variables.An ad hoc reporting tool can generate custom reports designed by theuser.

The graphical user interface 300 enables a client provider user tointerface with the client input subsystem 162 to access thefunctionality of the business intelligence subsystem 142 and the scoringsubsystem 144 of FIG. 1. The graphical user interface 300 may alsoenable the client provider to interface with the client input subsystem162 to access the functionality of the public payment portal subsystem146 and/or the private payment portal subsystem 148 of FIG. 1. Thegraphical user interface 300 may enable configuring settings, forexample, in a client-configured database in the datastore 121 of FIG. 1.

Business Intelligence

FIG. 4 illustrates one embodiment of a business intelligence subsystem142. The business intelligence subsystem 142 may comprise a reportengine 410, a filter engine 412, and a forecast engine 416. The reportengine 410 may be configured to generate reports 411 based on, interalia, the contents of the datastore 121. As disclosed above, the billingtransaction records 214 and corresponding payment transaction records216, account records 212, and/or entity records 210 may comprise alongitudinal portrayal of the transactions processed (e.g., originated)by billing systems coupled to the payment management system 102 (e.g.,billing systems coupled to the billing data sources 116A of FIG. 1). Thereport engine 410 may be configured to aggregate data pertaining tobilling transaction records 214 maintained in the data store 124 togenerate reports 411. The reports 411 may comprise aggregate datapertaining to a particular guarantor, billing system, hospital, clinic,service provider, and/or the like. A report 411A pertaining to aparticular guarantor may comprise a history of billing transactions inwhich a particular individual was a guarantor. The history maycorrespond to a particular time frame, visit type, and/or othercriterion. The report 411A may include information aggregated from aplurality of billing transaction records 214 and corresponding paymenttransaction records 216 (if payments have been made) that conform to theselection criterion. The report 411A may further include paymentmetrics, such as time to pay, payment method, insurance coverage, and/orthe like. The report 411A may, therefore, comprise a longitudinal,cohort-based portrayal of transactions pertaining to the guarantor. Asused herein, a cohort may be a group of guarantor accounts andcorresponding billing transaction records 214 and/or payment transactionrecords 216 that share a common origination characteristic (typically aspecific time period when an initial debt was incurred) and for whichpayment and debt resolution dynamics are tracked longitudinally overtime. The report 411A may include other information regarding theguarantor, such as credit history information, demographic information,and/or the like, which may be maintained in an entity record 210corresponding to the guarantor, as disclosed above.

The report engine 410 may be further configured to generate a report411B retaining to a particular billing system (e.g., hospital, clinic,service provider, professional, and/or the like). The report 411B mayinclude a history of billing transaction records 214 and/or paymenttransaction records 216 (if any) that satisfy a particular selectioncriterion (e.g., that pertain to services provided by a particularservice provider and/or managed by a particular billing system). Thereport engine 410 may be configured to generate other reports 411Ncorresponding to any suitable aspect of the payment management system102.

The filter engine 412 may be configured to dynamically filter thereports 411A-N to generate corresponding filtered reports 413A-N. Thefilter engine 412 may be configured to filter report data based on oneor more filter criteria. Exemplary filter criteria may include, but arenot limited to, clinic versus hospital billing (e.g., compare paymentmetrics of payment transactions of a particular clinic to paymenttransactions of a particular hospital), billing location, balance,patient and/or guarantor financial class (and/or other demographiccharacteristics), time frame, and/or the like. The business intelligencesubsystem 142 may be configured to make the reports 411 and/or filteredreports 413 available to the presentation tier 160 for display to auser. The business intelligence subsystem 142 may be further configuredto create reports 411 and/or filtered reports 413 in response to inputsprovided via the client input subsystem 162 and/or guarantor inputsubsystem 164. Alternatively, or in addition, the business intelligencesubsystem 142 may be configured to actively generate and/or updatereport data for use by the payment management system 102. The businessintelligence subsystem 142 may be configured to generate one or morereports 411 and/or filtered reports 413 in response to the extractionengine 122 injecting data of one or more data sources 116A-N into thedatastore 121. The reports 411 and/or filtered reports 413 may bemaintained in respective report records 219 in the datastore 121.

In some embodiments, the business intelligence subsystem 142 may furthercomprise a forecast engine 416, which may be configured to generate cashflow forecasts for both expected payer and patient cash payments onbalances residing on and off a provider's balance sheet (e.g., accountsreceivable, financing plans held off balance sheet, bad debt, etc.)based on, inter alia, PTP scoring data and historical paymentcharacteristics corresponding to the account records 212 and/or billingtransaction records 214.

The reports 411, filtered reports 413, and/or forecasts 419 generated bythe business intelligence subsystem 142 may incorporate one or more PTPscores and/or segmentation classifications. As disclosed above, a PTPscore refers to a PTP metric, which may be derived, in part, from dataacquired from the data sources 116A-N and, in particular, to billingand/or payment transaction records 214, 216. The application tier 140may comprise a scoring subsystem 144 configured to generate PTP scores.In some embodiments, the scoring subsystem 144 is configured to generatedifferent types of PTP scores based on a “stage” of an account (e.g.,account's status within the client provider's billing system, such aspre-A/R, NR, bad debt, etc.).

Scoring

FIG. 5A depicts one embodiment of a scoring subsystem 144. The scoringsubsystem 144 may comprise a staging module 510 configured to determinea stage of an account record 212 (and/or guarantor(s) associated withthe account record 212) and a scoring engine 516 to generate PTP scoresand/or segmentation identifiers (e.g., to identify a segmentationclassification) pertaining to the account record 212 and/orcorresponding guarantor(s) based on, inter alia, the determined stage.As used herein, an account stage refers to a payment status of anaccount record 212. Account stages may include, but are not limited to,an account creation stage (stage 0), a self-pay stage (stage 1), afinancing plan stage (stage 2), a bad debt stage (stage 3), a secondarybad debt (stage 4), and so on. The staging module 510 may be configuredto assign stages to account records 212 in response to particularconditions and/or criteria. The staging module 510 may be furtherconfigured to implement predetermined trigger actions in response toassigning an account record 212 to particular stages.

The staging module 510 may be configured to determine the current stageof an account record 212 based on data acquired from the billing datasources 116A (e.g., billing transaction records 214 and/or paymenttransaction records 216). In some embodiments, the staging module 510comprises a monitor 511 configured to detect staging events regardingaccounts managed by the payment management system 102. In someembodiments, the monitor 511 comprises stored procedural code configuredfor execution by the datastore 121 in response to particular conditions(e.g., a stored procedure, database trigger, or the like). As disclosedabove, the conditions pertaining to account staging may include, but arenot limited to, creation of and/or modifications to account records 212,billing transaction records 214, payment transaction records 216,financing plan records 218, and/or the like. Alternatively, or inaddition, the monitor 511 may be configured to query the datastore 121to identify events relevant to account staging and/or may be triggeredby the extraction engine 122 in response to, inter alia, the extractionengine 122 injecting data into the datastore 121.

In some embodiments, the staging module 510 includes an assignmentengine 512 configured to determine a current state of an account record212 in response to detecting relevant staging events in the datastore121 (by use of the monitor 511). The assignment engine 512 may designatean account record 212 as a stage 0 account in response to one or more ofthe following: a) creation of the account record 212 in the datastore121, b) associating the account record 212 with a non-adjudicatedbilling transaction record 214 (based on the bill type of the accountrecord 212), c) associating the account record 212 with a patient and/orguarantor (e.g., an entity record 210), and/or d) other similar actions.The assignment engine 512 may designate an account record 212 as a stage1 account (self-pay account) in response to associating the accountrecord 212 with an adjudicated, self-pay, and/or split-balance billingtransaction record 214. The assignment engine 512 may designate anaccount record 212 as a stage 2 account (financing plan) in response tocreating a financing plan record 218 corresponding to the account record212 (e.g., in response to setting up a financing plan for one or morebilling transaction records 214 associated with the account record 212).The assignment engine 512 may designate an account record 212 as a stage3 account (bad debt) in response to determining that the billing systemhas marked an account as bad debt and/or determining that a billingtransaction record 214 associated with the account record 212 has notbeen paid within a predetermined accounts receivable (AR) cycle of thecorresponding billing system (e.g., has remained unpaid for 120 days orlonger). The assignment engine 512 may designate an account record 212as a stage 4 account (secondary bad debt) in response to determiningthat the billing system has marked an account as secondary bad debtand/or determining that a billing transaction record 214 associated withthe account record 212 has not been recovered in a first bad-debtrecovery cycle. The assignment engine 512 may be further configured toupdate the account record 212 in the datastore 121 to indicate the stageassigned to the account record 212 (e.g., the account record 212 mayinclude a stage field configured to indicate the stage assignedthereto). Although particular stages and/or stage assignment criteriaare described herein, the disclosure is not limited in this regard andmay be adapted to assign account records 212 to any suitable stagecorresponding to any suitable payment management status and/oraction(s).

The staging module 510 may further comprise a trigger engine 513configured to implement one or more triggered actions 514A-E in responseto one or more of the following: a) assigning a stage to an accountrecord 212, b) updating data pertaining to an account record 212 in thedatastore 121, c) a request for updated stage assignment information,and/or d) other similar actions.

The triggered actions 514A corresponding to stage 0 (account creation)may include generating a front-end PTP score for the account record 212.

The triggered actions 514B corresponding to stage 1 (self-pay) mayinclude generating a healthcare PTP score corresponding to the accountrecord 212, sending PTP segmentation identifiers and/or information tothe corresponding billing system(s), and/or creating a record of aself-pay balance for use by the payment management system 102.

The triggered actions 514C corresponding to stage 2 (financing plan) mayinclude a) creating a financing plan record 218 corresponding to theaccount record 212 (if not yet created) and b) setting a due date forthe financing plan record 218. The due date may be used to determinewhether the account should be placed into stage 3 (bad debt) due tofailure to make timely payments.

The triggered actions 514D corresponding to stage 3 (bad debt) mayinclude a) determining whether the account record 212 is a candidate forpresumptive charity and/or b) generating a bad debt PTP score for theaccount record 212.

The triggered actions 514E for stage 4 (secondary bad debt) may comprisegenerating a secondary bad debt PTP score for the account record 212.

Determining whether an account record 212 is suitable for presumptivecharity may include calculating a charity score for the account record212 using, inter alia, PTP score(s) calculated for the account record212 and/or other data, such as a current health condition of the patientand/or guarantor(s), amount owed, income level, credit reportinginformation, and the like. For example, guarantors can be assessed forfinancial assistance eligibility by comparing a household incomeestimate and a size of household estimate to a percentage of the FederalPoverty Level to determine a charity write-off (e.g., for a givenhousehold size, some percentage of the Federal Poverty Level qualifiesthe guarantor for xx % charity write-off). Typically, an abundance ofguarantors become “eligible” according to this approach using strictly“estimates” of income and household size. These eligible guarantors canbe ranked according to PTP score(s) for each account record 212 todetermine how the charity write-offs are actually dispersed. A PTPthreshold can be adjusted up or down to either channel more or lessmoney to charity depending on a charity write-off budget.

A charity score may be calculated by receiving third-party data such asfrom a credit data source 116C and/or demographic/consumer data source116N (FIG. 1) to generate an ability-to-pay estimate or otherwisedetermine an ability-to-pay of a guarantor. The ability-to-pay estimatemay be compared to the provider's financial assistance eligibilitycriteria to determine whether the guarantor qualifies for financialassistance under the provider's charity or hardship programs. If charityeligible, a prioritization decision may determine which guarantoraccounts to recommend for presumptive charity based on a rank orderingby the PTP score.

A charity score may also be calculated using solely data from thebilling data source 116A and/or the healthcare data source 116B. Inother words, a charity score may be calculated without relying uponcredit reporting data (e.g., traditional credit bureau data) and/ordemographics/consumer data. The scoring engine 516 may be configured tocalculate a charity score for an account and determine whether theaccount is a candidate for presumptive charity by comparing the charityscore to a threshold. The staging module 510 may be configured toidentify account records 212 that are candidates for presumptive charityto an administrator of the payment management system 102, who mayselectively write off the candidate accounts.

The scoring engine 516 of the scoring subsystem 144 may be configured togenerate PTP scores 518 for account records 212. The scoring engine 516may be configured to generate PTP scores 518 in response to a) updatesto the datastore 121 (e.g., in response to receiving relevant data fromthe data sources 116A-N) and/or b) the triggered actions 514A-E of thetrigger engine 513 (e.g., active, always-on scoring). Alternatively, orin addition, the scoring engine 516 may be configured to generate otherPTP metrics, such as guarantor segment (or group) identifier, inresponse to requests received through, inter alia, interface(s) of thepresentation tier 160 (e.g., on-demand scoring). The other PTP metricsmay indicate a propensity to pay an amount owed. For example, aguarantor segment (or group) identifier may indicate a segment, group,classification, category, or the like, in which the guarantor belongs. Apropensity-to-pay may be associated with the metric (e.g., a guarantorgrouping) and thereby may indicate collection strategies for theguarantor and/or may be used to determine financing terms, similar tohow a PTP score can be used. The scoring engine 516 may be furtherconfigured to generate different types of PTP scores 518 in accordancewith a stage of the account records 212 and/or in response to requestsfor particular PTP score types (e.g., front-end PTP score, healthcare(HO) PTP score, bad debt (BD) PTP score, secondary BD PTP score, and soon).

FIG. 5B is a block diagram of another embodiment of a scoring subsystem144, comprising a scoring engine 516. The scoring engine 516 may includea PTP calculation module 520 configured to calculate PTP scores 518(scores 518A-N) for account records 212 by use of data pertaining to thepatient and/or guarantor(s) corresponding to the account records 212.The scoring engine 516 may include a PTP data aggregation module 517configured to access and/or derive the PTP data 525A-N for use by thePTP calculation module 520 to generate the PTP score(s) 518. The PTPdata aggregation module 517 may be configured to access PTP data 525A-Nextracted from the data sources 116A-N by the extraction engine 122, asdisclosed above. Accordingly, the PTP data aggregation module 517 may beconfigured to aggregate PTP data 525A-N from the contents of thedatastore 121 (e.g., from records 210, 212, 214, 216, and/or 218).Alternatively, or in addition, the PTP data aggregation module 517 maybe configured to request data from the data stores 116A-N (using thedata source adapters 123A-N of the extraction engine 122) to access dataas needed and/or in real time.

The PTP data aggregation module 517 may include one or more PTP dataaggregation engines 524A-N configured to aggregate particular types ofPTP data 525A-N. The PTP data aggregation module 517 may include, but isnot limited to, a healthcare transaction data aggregation engine 524A, ahealthcare condition data aggregation engine 524B, a credit dataaggregation engine 524C, a demographics data aggregation engine 524N,and so on. The healthcare transaction data aggregation engine 524A maybe configured to derive historical healthcare transaction data 525A froma history of billing transaction records 214, payment transactionrecords 216, and/or financing plan records 218 associated with theaccount record 212. The healthcare transaction data 525A may includeand/or be derived from billing transaction records, payment transactionrecords, and/or financing plan records associated with account recordsof one or more guarantors. The historical healthcare transaction data525A may include PTP characteristics of guarantors, which may include,but are not limited to, time to payment for healthcare transactions,late payments, payment amounts, insurance coverage, copayments, flexiblespending account activity (e.g., estimated remaining balance),healthcare spending account activity, financing plan history (e.g.,whether the patient and/or guarantor(s) have used a financing plan topay for services and/or whether the payments were made in a timelymanner), and so on.

The healthcare condition data aggregation engine 524B may be configuredto acquire information pertaining to a healthcare condition and/orstatus of the patient and/or guarantor(s) associated with the accountrecord 212. The healthcare condition data 525B may include, but is notlimited to, diagnoses, disease conditions, chronic health condition(s),degenerative conditions, and/or the like. In some embodiments, thehealthcare condition aggregation engine 524B is configured to derivehealthcare condition data 525B from billing transaction informationacquired from the billing data sources 116A (e.g., treatment codes,diagnostic codes, and/or the like). Alternatively, or in addition,healthcare condition data 525B may be acquired from a healthcare datasource 116B (e.g., directly from healthcare records of the patientand/or guarantor(s)).

The credit data aggregation engine 524C may be configured to aggregatecredit reporting data 525C pertaining to the patient and/or guarantor(s)of the account record 212. The credit reporting data 525C may beacquired and/or derived from one or more credit data sources 116C, asdisclosed above.

The demographics data aggregation engine 524N may be configured toaggregate demographics data 525N pertaining to the patient and/orguarantor(s) of the account record 212. The demographics data 525N maybe acquired and/or derived from one or more demographics/consumer datasources 116N, as disclosed above.

As illustrated in FIG. 5B, in some embodiments, the PTP data aggregationmodule 517 may be further configured to store PTP data 525A-N pertainingto the account records 212 (and/or individual patients and/orguarantors) in the datastore 121. The data aggregation engines 524A-N ofthe PTP data aggregation module 517 may update and/or modify the storeddata 525A-N rather than rebuilding the aggregated PTP data 525A-N eachtime PTP scores 518 are generated.

The PTP calculation module 520 may be configured to determine which PTPscore(s) 518A-N are to be calculated, and to request corresponding PTPdata 525A-N from the PTP data aggregation module 517. The PTPcalculation module 520 may select a type of PTP score(s) 518A-N tocalculate based on, inter alia, the stage assigned to the account record212, data availability, a request for a particular type of PTP score518A-N, and/or the like.

As illustrated in FIG. 5B, the PTP calculation module 520 may compriseone more calculation engines 522A-N, each of which may be configured tocalculate a respective type of PTP score 518A-N for guarantor(s). ThePTP scores 518A-N may correspond to particular account stages, asdisclosed above. The PTP calculation module 520 may include, but is notlimited to: a front-end PTP engine 522A configured to calculatefront-end PTP scores 518A, an HC PTP engine 522B configured to calculateHC PTP scores 518B, a BD PTP engine 522C configured to calculate BD PTPscores 518C, a second BD PTP engine 522N configured to calculatesecondary BD PTP scores 518N, and so on. PTP scores 518A-N may becalculated for particular patients and/or guarantor(s). The PTPassociated with an account record 212 may, therefore, correspond to PTPscoring information of the patient and/or guarantor(s) corresponding tothe account record 212.

The front-end PTP engine 522A may be configured to calculate a front-endPTP score 518A for a guarantor based on, inter alia, a) credit reportingdata 525C and/or b) demographics data 525N. The front-end PTP score 518Amay correspond to the PTP of a patient and/or guarantor(s) independentof healthcare transaction history and/or characteristics. The front-endPTP score can be used to guide front-end staff of an appropriatecollection tactic at the scheduling/registration of a patient before anyservices have been provided. For example, the front-end PTP score mayguide how much a patient/guarantor may be required to pay in advance or“arrange in advance” of receiving a treatment. The front-end PTP scoremay be generated for an estimate of charges for healthcare services tobe performed. The front-end PTP score may be based on and/or integratepreferences of the provider in terms of matching front-end tacticsaccording to such variables as type of treatment (emergent vs. scheduledand medically necessary vs. scheduled and elective), past paymentbehavior, prior discounts, balance range, etc. Recommended collectiontactics may include an amount of cash payment to require prior toproviding treatment, authorization for financing options, and the like.The front-end PTP score may allow creation of a financing plan andpayment authorization structure at time of service that would not beratified until after an insurance claim is adjudicated and a patientbalance is known. For example, if the estimate is $2,000, in order toproceed the patient may be required to establish an account in thepayment management system 102 and agree to a 10-month loan at $200 permonth. As another example, for maternity care, a patient may be requiredto funding a deposit balance (e.g., $300 per month for nine months) tofund the arrival of the baby and associated medical bills. The depositaccount balance may be tracked by an account in the payment managementsystem 102.

The HC PTP engine 522B may incorporate the data of the front-end PTPscore 518A (credit reporting data 525C and/or demographics data 525N) aswell as historical healthcare transaction data 525A and/or healthcarecondition data 525B. The HC PTP score 518B may, therefore, indicate aPTP based on historical healthcare payment activity of the patientand/or guarantor(s) and/or conditions affecting the patient and/orguarantor(s).

The BD PTP engine 522C may be configured to calculate a BD PTP score518C incorporating data 525A-N, and may include activity that hasoccurred during the AR cycle (e.g., partial payments, additional debtaccrued, updated historical healthcare transaction data 525A, updatedhealthcare condition data 525B, updated credit reporting data 525C,updated demographics data 525N, and so on).

The secondary BD PTP engine 522N may calculate a secondary BD PTP score518N based on further updates during bad debt recovery.

The PTP calculation engines 522A-N may incorporate similar sets of data(data 525A-N) to generate the PTP scores 518A-N. The PTP calculationengine 522A-N may differ with respect to the weighting and/orcombination of algorithms used to calculate the PTP scores 518A-N. Insome embodiments, the PTP calculation engines 522A-N are configured tocalculate PTP scores 518A-N by use of respective regression analysismodels 523A-N. The regression analysis models 523A-N may comprise PTPstatistical modeling data pertaining to sets of account records 212(e.g., accounts in particular stages 0-4). The regression analysismodels 523A-N may, therefore, correspond to different variable and/ordata weighting values for the PTP data 525A-N based on, inter alia,statistical estimation and/or modeling processes within the respectiveaccount record sets. Accordingly, the PTP scores 518 generated by thePTP engines 522A-N may differ significantly despite incorporatingsimilar sets of PTP data 525A-N.

The PTP scores 518A-N may be provided to a client provider billingsystem and/or presented to a provider via an interface, such as thegraphical user interface of the client input subsystem 162 of FIG. 1.Personnel or staff of a client provider may be enabled to trigger orotherwise request generation of the PTP scores 518A-N for use inregistering patients and in other interactions with patients and/orguarantors to improve collection of payment for services rendered by theprovider. In other embodiments, other PTP metrics may be generated andprovided to a client provider billing system. For example the scoringsubsystem may generate a guarantor segment (or group) identifier thatmay indicate a segment, group, classification, category, or the like, inwhich the guarantor belongs. A propensity-to-pay may be associated withthe metric (e.g., a guarantor grouping) and thereby may indicatecollection or other servicing strategies for the guarantor and/or may beused to determine financing terms, similar to how a PTP score can beused. Described differently, servicing strategies and or financing termsmay be associated with a guarantor grouping such that the associatedstrategies and financing terms may be known to apply to guarantors thatare within the guarantor grouping. The provider can use a segmentation(or group) identifier to either establish rules and policies within thebilling system for dictating the nature of allowed payment alternativesand financing plans or terms, and also indicate suggested servicingstrategies. Similarly, the payment management system 102 can use asegmentation (or group) identifier to establish similar rules andpolicies, dictate payment alternatives and financing plans or terms, anddetermine suggested servicing strategies.

In some embodiments, the scoring subsystem 144 may further include acharity evaluation module 527. The charity evaluation module 527 may beconfigured to identify account records 212 that are candidates forpresumptive charity (write-off). The charity evaluation module 527 maybe configured to identify presumptive charity candidates in response toaccount records 212 that satisfy charity conditions. In someembodiments, the charity evaluation module 527 is configured tocalculate a charity score 528 for an account record 212, which may bebased on, inter alia, one or more PTP scores 518 corresponding to theaccount record 212 (e.g., BD PTP score 518C) and an ability-to-paymetric that includes, but is not limited to, the amount owed asindicated by the historical healthcare transaction data 525A, thecondition of the patient and/or guarantor(s) as indicated by thehealthcare condition data 525B, debt level as indicated by the creditreporting data 525C, income level as indicated by the demographics data525N, and so on. The charity evaluation module 527 may be configured tocompare the charity score 528 to a predetermined threshold to determinewhether the corresponding account is suitable for presumptive charity.As illustrated in FIG. 5B, the charity score 528 and/or a correspondingindication of whether the account record 212 is a presumptive charitycandidate may be maintained in the datastore 121.

In some embodiments, the charity evaluation module 527 is configured todetermine charity eligibility based on demographic characteristics ofthe patient and/or guarantor (e.g., income estimate, size of household,and/or the like). The demographic characteristics may be comparedagainst poverty guidelines (e.g., Federal Poverty Level) and/or hospitalpolicy to identify accounts that fall within the client providers'policies for charity relief (e.g., 0%, 50%, 80% or 100% of poverty-levelcases). PTP scores 518A-N associated with the guarantor(s) may be usedto rank the identified accounts to determine an actual distribution ofcharity. Charity distributions may, therefore, be made to guarantorsthat are both a) eligible for charity according to the demographiccharacteristics disclosed above, and b) are least likely to be able topay according to the corresponding PTP scores 518. The charityevaluation module 527 may be further configured to hold out samples ofcharity eligible accounts that do not receive charity in order to, interalia, calculate an optimal point in a charity allocation curve where theforegone collection opportunity on charity accounts is optimized for thecommunity benefit of classifying an impaired asset as presumptivecharity rather than bad debt. A charity guideline may be adjusted usingthe PTP scores 518 in accordance with a specific charity target orbudget (while optimizing AR and charity account selection). Aspreviously noted, the PTP scores 518 may be determined based solely onhistorical transaction data tracked in a billing system (e.g., billingtransaction records 214, payment transaction records 216, and financingplan records 218), and without third-party data (e.g., credit reportingdata 525C).

The scoring subsystem 144 may further comprise a segmentation engine 537configured to determine a segment classification 538 for the accountrecord 212. The segment classification 538 may be used by other tiers,modules, components, and/or engines of the payment management system 102to manage the account record 212. The segmentation module 537 may beconfigured to assign segment classifications based on, inter alia, thestage assigned to the account records 212 and/or the PTP score(s) 518 ofthe account records 212. The segment classifications may include, butare not limited to, high risk, moderate risk, low risk, delayed payment,on-time payment, and/or the like. The segment classifications may beused to determine contact and/or billing procedures for account records212, such as contact frequency, contact type, financing plancharacteristics (e.g., whether the account record 212 is eligible for afinancing plan and/or the terms of the financing plan), interest ratesfor financing plans, and/or the like. The segmentation classifications538 may be based on a statistical distribution of the PTP scores 518,regression analysis, and/or the like. The segmentation classification538 of the account record 214 may be maintained in the datastore 121, asillustrated in FIG. 5B. The segmentation classification 538 may becommunicated to the client provider billing system(s) from which thehealthcare transaction data 524A originated. The segmentationclassification 538 may also be communicated to personnel of the clientprovider, such as via a graphical user interface. The segmentationclassification 538 may be communicated in addition to, or in lieu of,the PTP score(s) 518.

Referring back to FIG. 4, the forecast engine 416 of the businessintelligence subsystem 142 may be configured to generate forecasts 419based on, inter alia, the PTP scoring data 518 generated by the scoringsubsystem 144. The forecasts 419 may correspond to forecasted ARactivity pertaining to the account records 212 (e.g., forecast incomingpayment transaction records 216). Accordingly, the forecast engine 416may generate the forecasts 419 based on the probability that particularaccount records 212 will be paid and/or when payments for the particularaccount records 212 will be received. Accordingly, the forecast engine416 may be configured to calculate both a) probability of payment, andb) timing for the payment. As disclosed above, the PTP score(s) 518assigned to the account records 212 may correspond to paymentprobability. The PTP score(s) 518 may further include informationpertaining to an estimated time to pay (e.g., the PTP metrics of the PTPscores 518 may correspond to both PTP and payment delay). Alternatively,or in addition, the forecast engine 416 may calculate payment timingestimates 418 for account records 212 independently based on, interalia, the PTP score(s) 518, historical healthcare transaction data 525A,healthcare condition data 525B, credit reporting data 525C, and/ordemographics data 525N, disclosed above. The time-to-pay estimates maybe based on a regression analysis modeling using, inter alia, the PTPscore(s) 518 and/or segment classification(s) 538 calculated by thescoring subsystem 144.

Determining an accounts receivable forecast 419 may comprise scaling thepayments owed under a set of account records 212 by respective PTPscore(s) 518 of the account(s) and/or estimating a payment time of theaccounts based on the time-to-pay estimates, disclosed above. The PTPscore(s) 518 used to generate the forecasts 419 may be selected inaccordance with the stage assigned to the respective account records 212by the staging module 510.

The forecast engine 416 may be configured to generate forecasts 419pertaining to particular aspects of the payment management system 102including, but not limited to, forecasts 419A for particular timeframes, forecasts 4198 for particular billing entities (e.g., particularhospitals, clinics, service providers, and/or the like), forecasts 419Nfor particular billing locations, and/or the like. Generating atime-frame forecast 419A may comprise estimating accounts receivableactivity on all outstanding account records 212 based on correspondingPTP score(s) 518 and/or time-to-pay estimates, as disclosed above.Generating a billing entity forecast 4198 may comprise a) identifying aset of billing transaction records 214 corresponding to a particularbilling entity, and b) calculating an accounts receivable forecast 419based on PTP and/or time-to-pay metrics of the corresponding accountrecords 212, as disclosed above. Generating a location forecast 419N maycomprise a) identifying a set of billing transaction records 214corresponding to a particular location, and b) calculating an accountsreceivable forecast 4198 based on PTP and/or time-to-pay metrics of thecorresponding account records 212, as disclosed above. Althoughexemplary forecasts 419 are described herein, the disclosure is notlimited in this regard and could be adapted to generate forecastspertaining to billing transaction records 214 and/or account records 212selected and/or filtered based on any suitable criterion (e.g.,demographics, insurance type, socio-economic level, segmentclassification 538, and so on).

FIG. 6A is a flow diagram of one embodiment of a method 600 forgenerating PTP scoring data. Step 610 may comprise accessing and/oraggregating data from one or more data sources 116A-N. The PTP data mayinclude, but is not limited to: historical healthcare transaction data525A, healthcare condition data 525B, credit reporting data 525C,demographics data 525N, and/or the like.

Step 620 may comprise calculating a PTP score 518 for an account record212 by use of the PTP data 525A-N of step 610. Step 620 may compriseextracting PTP characteristics from the PTP data 525A-N, weighting theextracted characteristics, and/or combining the weighted characteristicsto calculate one or more PTP score(s) 518, as disclosed above. The PTPcharacteristics may include time to payment for healthcare transactions,late payments, payment amounts, insurance coverage, copayments, flexiblespending account activity (e.g., estimated remaining balance),healthcare spending account activity, financing plan history (e.g.,whether the patient and/or guarantor(s) have used a financing plan topay for services and/or whether the payments were made in a timelymanner), a total amount presently owed to a provider (or one or moreclient providers), prior bad debt charge-offs, prior hardship programassistance (charity), time periods between transactions, and disputehistory.

In some embodiments, step 620 further comprises determining a stageassociated with the account record 212. As disclosed above, stageassignments may be based on account and/or billing transaction events,such as account creation, billing adjudication, self-pay, split balance,bad debt, secondary bad debt, and/or the like. Step 620 may comprisecalculating a particular PTP score 518A-N based on the assigned stage.Accordingly, step 620 may comprise calculating one or more of afront-end PTP score 518A, an HC PTP score 518B, a bad debt PTP score518C, a secondary bad debt PTP score 518N, and/or the like.

In certain embodiments, one or more of the PTP score(s) 518 calculatedat step 620 incorporate historical healthcare transaction data 525Apertaining to the patient and/or guarantor(s). The one or more PTPscore(s) 518 may, therefore, incorporate characteristics and/or metricsthat are specific to healthcare transactions of the patient and/orguarantor(s). Such characteristics may include, but are not limited to,historical payment amounts, historical time to payment, bad debt (ifany), secondary bad debt (if any), payment types, payment relationships(e.g., guarantor on other healthcare transactions), and/or the like.

In certain embodiments, one or more of the PTP score(s) 518 calculatedat step 620 incorporate information pertaining to a health condition ofthe patient and/or guarantor(s). As disclosed above, informationpertaining to health condition(s) of the patient may be derived frombilling transaction information provided by the billing data source(s)116A. The health condition(s) may be determined based on conditionand/or diagnosis coding information in the billing information. Thehealth condition(s) of the guarantor (if different from the patient) maybe determined based on separate billing transaction information obtainedfrom one or more other healthcare billing data sources 116A (e.g., otherpatient visits, diagnosis, and/or the like). Alternatively, or inaddition, information pertaining to the health condition of the patientand/or guarantor(s) may be obtained from a separate healthcare datasource 116B. The health condition of the patient and/or guarantor(s) maybe used to determine payment probability and/or timing (patients withserious conditions may not be in a position to pay in a timely manner).

Step 620 may further comprise calculating a charity score 528 for theaccount record 212, which, as disclosed above, may be used to identifyaccounts that are candidates for write-off (presumptive charity). Step620 may further comprise assigning a segment classification 538 to theaccount record 212, as disclosed above.

FIG. 6B is a flow diagram of one embodiment of a method 601 for accountsreceivable forecasting. Step 611 may comprise accessing a set of accountrecords 212. The account records accessed at step 611 may be selectedaccording to a selection criterion, such as time frame, billing entity,billing location, service provider, location, patient type, and/or thelike. Accordingly, step 611 may comprise filtering the account records212 to identify account records 212 that conform to one or more of thecriteria.

Step 621 may comprise generating a forecast corresponding to accountsreceivable activity pertaining to the set of account records 212accessed at step 611. Step 611 may comprise determining a likelihood ofpayment transactions on the set of accounts during a particular timeperiod (and/or whether any payment will be received). The forecast ofstep 621 may incorporate a) PTP score(s) 518 of the account records 212and/or b) time-to-pay estimates of the account records 212. Thetime-to-pay estimates may be derived from PTP score(s) 518 of theaccount records 212 and/or PTP data 525A-N, as disclosed above.

Public Payment Portal Subsystem

FIG. 7 is a block diagram of a public payment portal subsystem 700 of asystem for managing payments for healthcare services, according to oneembodiment. The public payment portal subsystem 700 includes a processor702 (or more than one processor 702), a memory 704, an authenticationengine 706, and a payment clearance and routing engine 708. The publicpayment portal subsystem 700 can facilitate payments from a guarantorwith obligations on any one of multiple billing systems that a clientprovider may use. As noted, a client provider may employ multipledifferent billing systems for different aspects of its business. Thepublic payment portal subsystem 700 enables a single guarantor interfacefor any of the different billing systems. The public payment portalsubsystem 700, in combination with a guarantor input subsystem, canprovide a uniform interface at which guarantors can interface withmultiple billing systems of a client provider. The public payment portalsubsystem 700 further posts transactions automatically to the respectivebilling system without a need for manual intervention. If a receivedpayment cannot be matched to a guarantor account, an exception file maybe created and introduced to a work queue, such as a mismatched recordswork queue, for the client provider to manually search accounts andmatch payments accordingly.

The authentication engine 706 may interface with the datastore 121 ofFIG. 1 to obtain guarantor data and visit data and/or visit charge data.The visit charge data may be extracted or otherwise received from aclient provider billing system. A unique identifier may be included withthe data that can be used by the guarantor to authenticate access intothe public payment portal subsystem 700. The authentication engine 706may use the unique identifier to coordinate which visit charges are tobe paid by a guarantor.

The payment clearance and routing engine 708 may coordinate transactionauthorization and payment processing. The payment clearance and routingengine 708 may interface with a payment gateway that facilitates and/orcoordinates payment from the guarantor's financial institution and theclient provider's financial institution. The payment clearance androuting engine 708 may also coordinate communication to the billingsystem when a payment transaction is completed or otherwise effectuated.

FIG. 8 is a flow diagram of a method 800 of processing payments,according to one embodiment. Visit charge data is received 802 from abilling system. The visit charge data may be extracted by an extractionengine or may be pushed from the billing system. The visit charge datathat is received 802 may include a charge amount, a patient name, aguarantor name, and a unique identifier that may correspond to thecharge for the visit. The unique identifier may be a statementidentifier. The guarantor that wishes to make a payment via the publicpayment portal subsystem may provide authentication information. Theauthentication information is received 804 to coordinate which chargesare being paid. The authentication information may include the uniqueidentifier. The authentication information may also include otherinformation such as the patient name, guarantor name, and/or anidentifier of such individual or entity (e.g., an SSN or portionthereof).

Once authentication information is received 804 that corresponds to thereceived 802 visit charge data, the user may be able to specify apayment vehicle and amount. User input is received 806 specifying thepayment vehicle (e.g., the guarantor's credit card, debit card, bankaccount, Health Savings Account, or the like) and specifying a paymentamount. A financial transaction authorization request is generated 808.The transaction is processed 810 between the guarantor financialinstitution and the client provider financial institution. Theprocessing 810 may be facilitated and/or performed by a payment gateway.Authorization for the transaction may be granted and thus received inresponse to the transaction authorization request. Alternatively,confirmation of the transaction may be received. Once the transactionhas been completed or otherwise effectuated, the billing system may benotified 812 of the transaction. The notification may occur bygeneration of a transaction posting file that may be transmitted to thebilling system.

The payment posting files may include, but are not limited to, thefollowing: an identifier (e.g., a billing system assigned identifier ata charge level, at the visit charge level, or at the guarantor level), atransaction amount (e.g., a positive or negative amount that may includemultiple fields for principle, interest, commission, etc.), atransaction code to define the type of transaction (e.g., patientpayment, prompt-pay discount adjustment, interest charged, interestpaid, etc.), a reference number (e.g., a field which can be loaded alongwith the payment and extracted again to load back to the paymentmanagement system for use in identifying which payments have or have notyet been posted back into a billing system), a transaction date, and atext note (e.g., text to be shown in the user interface of the billingsystem).

The public payment portal subsystem may enable receiving and/orconfiguring instructions to make recurring payments (e.g., configurefinancing plans) to pay for visit charges. For example, thepatient/guarantor could decide to make four payments (e.g., $250 each ona $1,000 obligation) and schedule each of those payments to occur on aperiodic basis (e.g., monthly) over four months. An anonymous uniquetransaction authorization identifier (e.g., a token received from athird-party gateway) may be received and stored. The anonymous uniquetransaction authorization identifier or a similar token could then bepresented again to the gateway in the ensuing months to effectuate therecurring transactions.

Guarantor Input Subsystem

FIG. 9 illustrates a user interface 900, according to one embodiment, ofa guarantor input subsystem. The guarantor input subsystem may be theguarantor input subsystem 164 of the payment management system 102 ofthe system 100 of FIG. 1. The guarantor input subsystem 164 enablesinterfacing with the public payment portal subsystem 146 and/or theprivate payment portal subsystem 148 of FIG. 1.

The user interface 900 of FIG. 9 illustrates private user access inwhich the guarantor input subsystem interfaces with the private paymentportal subsystem to enable access and/or presentation of PHI. Privateuser access interfacing with the private payment portal subsystem mayrequire user login and password information. Upon login, the userinterface 900 may display to provide a viewing guarantor with anoverview of the guarantor's account and/or any accounts managed by theguarantor. As briefly mentioned above, and explained more fully belowwith reference to FIGS. 17 and 18, the private payment portal subsystemmay generate and provide to a guarantor an electronic statement for agiven period (e.g., a one-month statement period), configure statementpreferences (e.g., statement date and/or due date), configure automatictransactions (e.g., payment date, payment method), pay new charges forvisits that occurred during the statement period, finance and/orconfigure a new financing plan for new visits from the current statementperiod, consolidate billing by agreeing to manage the account of anotherguarantor (e.g., consolidate household billing by managing a spouse'saccount), add visits the guarantor believes should be reflected in theguarantor's account but were previously unmatched due to a variety ofissues (e.g., data input error, incomplete data, typographical error),and view past transaction data. The user interface 900 may provide aninteractive overview of an electronic statement that may include anaccount overview area 902, an autopay overview area 904, a paymentoptions area 906, and an account summary area 908.

The account overview area 902 displays a brief overview of a currentbalance on the account (including all managed accounts), a statementbalance (including all managed accounts), a next payment date, and anext statement date.

The autopay overview area 904 displays information relating to payments(or amounts of money) that are pending to be automatically deducted froma preconfigured payment vehicle (e.g., the guarantor's credit card,debit card, bank account, or Health Savings Account) or according to apreconfigured payment methodology for existing financing plans as wellas preset payment arrangements for current statement charges.

The payment options area 906 displays options for paying for healthservices rendered during new visits (or visits pertaining to a currentstatement period). The payment options may include paying the currentvisits balance in full to potentially receive a discount. The discountmay be configured by the client healthcare provider that provided thehealthcare services to the patient. The payment options may also includean option to finance payment for healthcare services rendered during newvisits for the current statement period. The user interface 900 mayenable the guarantor to configure financing terms that may better fit abudget of the guarantor or otherwise be more workable for the guarantorto successfully pay in full, or over time, for the charges for thehealthcare services rendered for the visits. The user interface 900 mayalso indicate preset financing terms which may be accepted by theguarantor. The user interface 900 may be configured to indicateautomatic acceptance of the preset financing terms if another paymentoption is not selected. The preset financing terms may be preconfigured,for example, by the client healthcare provider. The illustrated userinterface 900 of FIG. 9 indicates that the preset (or standard)financing terms are four months at 0.00% interest.

The account summary area 908 displays information summarizing a currentstatus of the account, including a summary of the current statementperiod and a summary of recent activity.

A “Statements” link 910 is provided on the user interface 900 to enablethe logged in guarantor to access an electronic statement of theguarantor's account. A “My Visits” link 912 is provided on the userinterface 900 to enable the guarantor to access and view informationabout visits included or otherwise associated with the account of theguarantor or with an account managed by the guarantor. A “My Financing”link 914 is provided on the user interface 900 to enable the guarantorto access information pertaining to financing plans that the guarantorhas taken out to finance payment for healthcare services. A “My PaymentHistory” link 916 is provided on the user interface 900 to enable theguarantor to access information pertaining to payments the guarantor hasmade in direct payment for healthcare services rendered or in paymenttoward financing plan balances for financing plans taken out to financepayment for healthcare services.

The user interface 900 also includes a manage account tab 920, apayments and financing tab 922, and a support tab 924. The manageaccount tab 920 enables a guarantor to access account management toolsand/or functionality, such as viewing and/or modifying personalinformation, accessing account statements, accessing information aboutvisits, and managing a household (e.g., linked accounts). The paymentsand financing tab 922 enables a guarantor to access information relatingto payments of the guarantor and financing plans the guarantor may havetaken out to finance payment for healthcare services. The informationmay include a listing of financing plans, a listing of payment methods,pending payments (e.g., automatic transactions that are scheduled), anda payment history. Functionality may also be provided on the paymentsand financing tab 922 to review (e.g., forensically “trace”) where agiven payment was applied (e.g., to which billing system accounts,visits, and visit charges). The support tab 924 enables a guarantor toaccess support information.

As noted above, the user interface 900 of FIG. 9 provides private useraccess in which the guarantor input subsystem interfaces with theprivate payment portal subsystem to enable access and/or presentation ofPHI.

The user interface 900 of FIG. 9 may also provide a linking indication926 to indicate accounts that may be linked to the guarantor's account,and more specifically to indicate accounts the guarantor may bemanaging.

Private Payment Portal Subsystem

FIG. 10 is a block diagram of a private payment portal subsystem 1000 ofa payment management system, according to one embodiment. The privatepayment portal subsystem 1000 includes a processor 1002 (or one or moreprocessors), a memory 1004, a registration engine 1006, anauthentication engine 1008, a guarantor linking engine 1010, a guarantormatching engine 1012, a visits batching engine 1014, a statement engine1016, a payment terms management engine 1018, a payment clearance androuting engine 1020, a dispute engine 1022, a financing engine 1024, abalance brokering engine 1026, a principle and interest calculationengine 1028, and a management engine 1030.

The registration engine 1006 provides functionality to enable aguarantor to register for access to the private payment portal subsystem1000. The registration engine 1006 receives information for guarantorsand pre-approval or acceptance of registration from a client provider.The information for guarantors may be received and stored in apatient/guarantor database in the datastore 121 of FIG. 1. Thepre-approval and/or information for the guarantors may be obtained froma database in the datastore 121.

The authentication engine 1008 may receive user login and passwordinformation and authenticate a guarantor, to confirm the guarantor isregistered, before allowing access to the private payment portalsubsystem 1000 and PHI accessible therethrough. The authentication mayaccess registered guarantor information extracted from, for example, abilling system and stored in a database in the datastore 214. Theauthentication engine 1008 may also perform more rigorousauthentication, for example, at registration or at login. For example,the authentication engine 1008 may cross check guarantor informationwith third-party data sources to perform identity verification (e.g.,looking for one or more matches to a name, address, SSN, email, etc.) oralternatively offering multifactor authentication.

The guarantor linking engine 1010 may provide functionality for linkingaccounts. For example, a first guarantor may request a second guarantorto manage the first guarantor's account (e.g., a request to be managed),or the first guarantor may request to manage the second guarantor'saccount (e.g., a request to manage). The guarantor linking engine 1010enables a first guarantor to request or assign (and a second guarantorto accept) managerial responsibilities for the first guarantor'saccount. The second guarantor, upon accepting managerialresponsibilities, accepts financial responsibility for the accountand/or obligations of the first guarantor (or managed guarantor). Theguarantor linking engine 1010 may also enable either party to sever alinkage at any time, such that the formerly managed guarantor (e.g., thefirst guarantor) again assumes responsibility for all past and currentobligations. The guarantor linking engine 1010 implements andfacilitates ensuring any necessary permissions and releases are properlyexecuted, managed, and/or stored.

The guarantor matching engine 1012 may identify orphan, unmatched, orotherwise unassociated accounts (e.g., including charges, payments, andother obligations and/or transactions) within and across one or morebilling systems for a guarantor. Described differently, the guarantormatching engine 1012 can identify unmatched accounts in a billing systemthat should be associated with a guarantor account record in the paymentmanagement system, can determine the guarantor account those unmatchedbilling system accounts should be associated with, and can associatethose unmatched billing system accounts to the appropriate guarantoraccount record in the payment management system. The guarantor matchingengine 1012 may utilize a matching algorithm that may use or otherwiseconsider, for example, one or more of: a name of the patient orguarantor on the unmatched transaction, at least a portion of an IDnumber (e.g., an SSN, driver's license), a date of birth, and anaddress. Once the match or association is made, the formerly unmatchedaccounts may be tracked in this associated format even if theoriginating billing systems do not realize these accounts should be tiedto the same guarantor and are not properly associated in the billingsystem itself. The guarantor matching engine 1012 may allow a guarantorto match an account in a billing system that the guarantor may be awareof, such as by receiving a paper billing statement from a billing systemof the client healthcare provider. The visit and/or corresponding visitcharges may belong to the current guarantor (or a currently managedguarantor), but may reside in a different billing system of the clientprovider from other visits and corresponding visit charges that areproperly reflected on the electronic statement. The account of theguarantor within the different billing system may be unmatched to theaccount of the guarantor associated with the electronic statement. Theaccount matching functionality that is provided by the guarantormatching engine 1012 enables the guarantor to locate the missing visitdata and match the associated billing system account with theguarantor's account corresponding on the payment management system. Oncean unmatched account in a billing system is associated with a guarantoraccount in the payment management system (either through matching logicor if the user manually links an otherwise orphan account), thatassociation persists even though the billing system itself may notrecognize the relationship. In other words, the billing system may notbe updated based on the matching process. The billing system trackingremains independent of the payment management system tracking.

The visits batching engine 1014 may associate all visits for a givenguarantor (or group of linked guarantors) during a specific period oftime (e.g., monthly) and present this aggregated pool of obligations asa batch of open charges and/or an open charges balance for payment orfor financing. The visits batching engine may compile visit data and/orvisit charge information for the statement engine 1016.

The statement engine 1016 may gather visit data and/or visit charge datato generate and provide electronic statements. The statement engine 1016may also enable a guarantor to view a listing of the visits associatedwith his account, sort them, filter them, understand how payments wereapplied to principal or interest, etc. The statement engine 1016 mayalso enable a user to drill down on a visit to view more detailedinformation. The statement engine 1016 may also present functionality(e.g., a link or button) to enable a guarantor to access the disputeengine 1022 to dispute a visit charge on the electronic statement.

The payment terms management engine 1018 may compare authorized paymentterms with the specific characteristics of a given guarantor (includingoutputs of the scoring subsystem) to determine what payment offersshould be made available to the given guarantor. The payment offers mayinclude prompt payment discounts, financial hardship discounts, otherdiscounts, and the like. The authorized payment terms may bepreconfigured by a provider or other asset holder with legal ability tocollect a payment. The provider or asset holder may configure differentauthorized terms for different groups, segments, or classifications ofguarantors. A guarantor may be grouped by provider-level,guarantor-level, and/or visit-level decisioning and/or underwriting suchthat any visit or set of visits for any patient and/or for any guarantorcan be channeled a customized payment offer. The decisioning may includedecisioning rules that define criteria to group guarantors. Thecriteria, as mentioned, may be at a provider-level, a guarantor-level,and/or a visit-level (e.g., provider, guarantor income estimate, balanceamount, insurance carrier, type of treatment, etc.). Providers can alsoenable automated discounts for uninsured patients pursuant to theprovider's policies.

The payment clearance and routing engine 1020 may facilitate paymenttransactions. For example, the payment clearance and routing engine 1020may generate transaction authorization requests for interfacing with apayment gateway. The payment clearance and routing engine 1020 may alsogenerate transaction posting files to communicate to a billing system acompleted or otherwise effectuated payment transaction. The paymentclearance and routing engine 1020 may first clear a financialtransaction between a guarantor's bank and a provider's (or assetholder's) bank, facilitated by a third-party payment gateway, and thendisaggregate that singular monthly payment to multiple visits (accounts)of the one or more originating billing systems. The payment clearanceand routing engine 1020 creates posting files that allocate anappropriate payment amount to the appropriate visits (accounts) withineach of the relevant billing systems (with further allocation toprinciple and interest amounts in the relevant system of record). Thepayment amount could be a combination of the amount due on the currentmonth's batch of visits plus any monthly payments due on prior batchesthat have been financed.

The payment posting files may include, but are not limited to, thefollowing: an identifier (e.g., a billing system assigned identifier ata charge level, at the visit charge level, or at the guarantor level), atransaction amount (e.g., a positive or negative amount that may includemultiple fields for principle, interest, commission, etc.), atransaction code to define the type of transaction (e.g., patientpayment, prompt-pay discount adjustment, interest charged, interestpaid, etc.), a reference number (e.g., a field which can be loaded alongwith the payment and extracted again to load back to the paymentmanagement system for use in identifying which payments have or have notyet been posted back into a billing system), a transaction date, and atext note (e.g., text to be shown in the user interface of the billingsystem).

The dispute engine 1022 may enable dispute functionality for allowing aguarantor to dispute a visit charge on a statement or otherwisefacilitate communication between a guarantor and a provider to addressissues. A dispute may include a claim that insurance coverage wasavailable or misapplied, a dispute of a charge, a request for charity orother financial assistance, or any other issue, concern, or situation inwhich a guarantor desires a client provider to reconsider a visit chargeand/or to contact the guarantor regarding a visit charge. The disputeengine 1022 may enable secure two-way electronic communication betweenthe guarantor and the client provider. The dispute engine 1022 maychange a status of visit charges to “suspended” and/or remove the chargefrom the account balance until the dispute is resolved. The disputeengine 1022 may also implement or interface with one or more workqueues, such as a dispute queue, to queue disputes or other issues forresolution by the client provider.

The financing engine 1024 may provide functionality for configuringfinancing plans to pay account balances. The financing engine may use aPTP score, or other output of the scoring subsystem 144 of FIG. 1, withdecisioning rules (e.g., underwriting limit selections) configured by aprovider or asset holder to establish financing offers that are madeavailable to a guarantor desiring to finance a batch of visit charges.The amount for current open charges (e.g., an open charges balance) of acurrent batch of visit charges (e.g., for each statement period'svisits) can be financed according to a new financing plan with uniqueterms, which may be preset financing terms or financing terms selectedor configured by the guarantor (subject to authorized financing termsconfigured by the provider or asset holder).

The financing engine 1024 may enable provider-level, guarantor-level,and/or visit-level decisioning and/or underwriting such that any visitor set of visits for any patient and/or for any guarantor can bechanneled customized financing terms. The decisioning may includedecisioning rules that define criteria to group guarantors. Thecriteria, as mentioned, may be at a provider-level, a guarantor-level,and/or a visit-level (e.g., provider, guarantor income estimate, balanceamount, insurance carrier, type of treatment, etc.).

The financing engine 1024 may enable a provider or asset holder toconfigure various pre-set financing options, each having terms for agroup, segmentation, or other classification of guarantors, asdetermined by the decisioning rules. As stated, the decisioning can beat a provider level, a guarantor level, and/or a visit level. Thefinancing engine 1024 may apply the decisioning rules to group aguarantor, and then may present one or more pre-set financing optionscorresponding to the group of the guarantor. Described differently, thefinancing engine 1024 may determine which pre-set financing option(s) topresent to a guarantor based upon criteria of the guarantor at one ormore of a provider level, a guarantor level, and/or a visit level.

The financing engine 1024 may allow a guarantor to createself-configured financing plans, for example, by choosing a monthlypayment amount and subsequently accepting the associated terms theprovider has authorized for the resulting amortization schedule (e.g.,minimum payment amount, maximum amortization period, interest rates,etc.). Self-configured financing plans may be configured by theguarantor choosing any one or more of an interest rate, a paymentamount, a period for repayment, and/or other terms that can be comparedto provider-authorized terms and/or associated with provider-authorizedterms that can be accepted by the guarantor. Again, the financing engine1024 may enable a provider or asset holder to configure variousguarantor-configurable financing options, each providing authorizedterms for a group, segmentation, or other classification of guarantors,as determined by the decisioning rules. As stated, the decisioning canbe at a provider level, a guarantor level, and/or a visit level. Thefinancing engine 1024 may apply the decisioning rules to group aguarantor, and then may present one or more guarantor configurablefinancing options corresponding to the group of the guarantor. Describeddifferently, the financing engine 1024 may determine which set ofauthorized financing terms apply for a guarantor configurable financingoption presented to a guarantor. The determination of which set ofauthorized financing terms apply may be based upon criteria of theguarantor at one or more of a provider level, a guarantor level, and/ora visit level.

The financing engine 1024 may allow a guarantor to have multiplefinancing plans active simultaneously and can enable one monthly paymentfor all open financing plans. In other words, a new financing plan for acurrent open charges balance is stacked on previously establishedfinancing plans for prior open charges balances.

The balance brokering engine 1026 may enable brokering of charges and/orbalances. A balance for a batch of open charges, or an open chargesbalance can be automatically evaluated based on one or more pre-definedevaluation criteria to determine whether the open charges balance shouldbe transferred to a new system of record associated with a new entity.The balance brokering engine 1026 may evaluate the batch of open chargesand/or open charges balance based on the pre-defined evaluationcriteria. If the one or more pre-defined evaluation criteria are met,the balance brokering engine may automatically effectuate electronictransactions to transfer the open charges balance to an entityassociated with the new system of record. More particularly, the balancebrokering engine 1026 may automatically effectuate electronictransactions to transfer title of an accounts receivable asset thatconstitutes some or all rights to collect payment for the open chargesbalance.

The balance brokering engine 1026 may also integrate providerconfiguration settings with each guarantor's desired financing choice todetermine which system of record should hold the new asset (e.g., anaccounts receivable asset or financed balance asset). Once thatdetermination is made, the balance brokering engine 1026 may calculatean appropriate pricing construct established between the provider and apotential new asset holder (e.g., a third-party entity or creditor, suchas an owner or operator of the payment management system, a bank, oranother special purpose lending or financial institution). The balancebrokering engine 1026 may facilitate a financial transaction from thenew entity (new asset holder) to the provider to clear the guarantorbalance from the provider's system of record (e.g., billing system). Thebalance brokering engine 1026 may post the transferred asset (e.g.,purchased asset) to an appropriate billing system of the new assetholder and subsequently integrate with the payment clearance and routingengine 1020 and statement engine 1016 to accurately clear payments andpresent accurate account balances for both the provider and the newasset holder.

The principle and interest calculation engine 1028 may calculate aschedule of interest accruals and principle payments due over anamortization schedule for a given financing construct. The principle andinterest calculation engine 1028 may dynamically recalculate interestand principle allocations as payments and other debit and creditadjustments flow through the systems of record (e.g., provider billingsystems, asset holder billing systems) over time.

The management engine 1030 may interface with the client input subsystem162 and/or the guarantor input subsystem 164 of FIG. 1 to enable aclient provider to generally manage users. The management engine 1030may enable the client provider to register or approve guarantors orotherwise facilitate completion of the registration process. This mayentail reviewing requests for accounts and offering or declining access,and resetting passwords or security credentials. The management engine1030 may also enable a client provider to manage and respond to (orotherwise address) user requests and guarantor disputes. The clientprovider may also be able to emulate actions a user can take, such asreviewing transactions and activity for a given account, linkingaccounts or severing accounts, initiating new financing plans,reconfiguring existing financing plans, or resetting a payment date. Themanagement engine 1030 may enable a client provider to: set a maximumduration for financing plans, set a minimum payment amount, set interestrates for given duration periods, set preset financing plan parameters(e.g., interest rate, if any, and plan duration), set a prompt-paydiscount (if any), set an uninsured patient discount, allow or disallowaccount linking, manage work queues (including a disputes work queue, adelinquent accounts queue, and the like), publish promotional messageson a splash page, offer rewards/incentives for payment, configureprovider contact information, work and manage non-sufficient fundstransactions, perform payment reconciliation, monitor transactionreporting, and manage exceptions.

FIG. 11 is a flow diagram of another method 1100 of managing payments,according to one embodiment. Guarantors can register 1102 for privateaccess, such as to features and functionalities provided by a privatepayment portal subsystem. Data is extracted 1103 or otherwise receivedor accessed, for example, from a billing data source (e.g., one or morebilling systems), from a credit data source, and/or from a demographicsdata source. The data that is extracted 1103, or a portion thereof, mayenable linking accounts, presentment of statements and charges, chargedispute processing, and payment processing.

When a registered guarantor logs in, the login of the guarantor may beauthenticated 1104 to help ensure that PHI is being provided to anappropriate viewer (e.g., a guarantor or a manager guarantor).

Accounts of registered guarantors can be linked 1106 so that a singleguarantor (a manager guarantor) can manage linked accounts, such as theaccount of a spouse, a parent, or the like. A statement or similarlisting of charges on a guarantor's account and all other guarantor andpatient accounts the guarantor manages can be presented 1108 to enablethe guarantor to understand a balance (e.g., any balance) on the accountand to enable the guarantor to arrange payment. A guarantor can arrangepayment using either a singular payment to meet payment requirements onall subsidiary accounts (current visits and visits on financing plans)or direct specific payments to individual visits on a one-off basisthrough either one aggregated payment with allocation detail selected bythe guarantor or multiple individual payments at the guarantor'sdiscretion. A guarantor can also dispute a charge presented for payment.The dispute may be processed 1110, such as by temporarily removing thedisputed charge from the account balance until resolution of thedispute. The dispute may be automatically entered in a dispute workqueue for processing, for example, by the client provider. Paymentoptions can be presented and a selection of an option can be receivedand processed 1112. The payment options may include, but are not limitedto, payment in full, guarantor-configured financing terms, or pre-setfinancing terms.

FIG. 12 is a flow diagram of a method 1200 of registering a guarantor,according to one embodiment. Pre-approved candidate guarantors may beselected by the client provider, and information for those pre-approvedcandidate guarantors may be received 1202 from the client provider. Theclient provider may have obtained the information for potentialcandidate guarantors during visits (e.g., by the guarantor or apatient-guarantee of the guarantor), and a screening process maydetermine which potential candidate guarantors are pre-approved.Business intelligence information (e.g., generated by a businessintelligence subsystem) and scoring information (e.g., generated by ascoring subsystem) may aid a client provider in such a screening processto select pre-approved candidate guarantors. An invitation to registerfor payment management is generated 1204 and transmitted or otherwisecommunicated to the candidate guarantor. The candidate guarantor mayprovide authorization for the payment management, and the authorizationmay be received 1206. For example, the generated invitation may be anemail including a link (e.g., an Internet URL). The link may provide thecandidate access to interface with the private payment portal subsystemand functionality provided therefrom for accepting the invitation tobecome a registered guarantor. As another example, the link may providefunctionality for the candidate to directly accept the invitation tobecome a registered guarantor. As another example, the generatedinvitation may include instructions for accepting the invitation, suchas sending an email to a particular email account, going to a particularwebpage, calling a phone number, providing a passcode, or the like.Authentication (e.g., identity verification) may also be performed atregistration such as by cross-checking received guarantor informationwith third-party data sources to perform identity verification (e.g.,looking for one or more matches to a name, address, SSN, email, etc.) oralternatively offering multifactor authentication.

Upon registering, a registered guarantor can provide communicationpreferences, which may be received and stored 1208. The communicationpreferences may include, but are not limited to, preferences specifyingmanner, format, timing, and the like, for providing information to theguarantor concerning the guarantor's account (including accounts linkedto the guarantor's account for which the guarantor has assumedmanagement). A registered guarantor may also provide paymentpreferences, which may be received and stored 1210. The paymentpreferences may include, but are not limited to, preferences specifyingmanner (e.g., payment vehicle), format, timing, and the like, for makingpayments on the guarantor's account. The payment preferences may enablecontacting or otherwise interfacing with a payment gateway (e.g., thirdparty) or a financial institution of a payment vehicle, which maygenerate an anonymous unique transaction identifier that can be used tofacilitate payment transactions. The anonymous unique transactionidentifier is received 1212 and stored for use during paymentprocessing. The anonymous unique transaction identifier may link theguarantor's account to a previously specified financial services accountfor subsequent payment authorizations. The anonymous unique transactionidentifier may facilitate recurring transactions (using the specifiedfinancial services account) without storing payment card industry (PCI)information, such as account numbers and credit card numbers. Theanonymous unique transaction identifier may be, for example, a tokenthat is generated by a third-party payment gateway and can be used tofacilitate a payment through that payment gateway.

FIG. 13 is a flow diagram of a method 1300 of registering a guarantor,according to another embodiment. The client provider may allow openenrollment, and authorization for open enrollment may be received 1302from the client provider. Registrant information (e.g., name, address,phone number, SSN) and/or acceptance of terms and conditions may bereceived 1304. The acceptance of terms and conditions may include a formof credit agreement. The client provider may be notified 1306 of theregistration of the registrant to allow the client provider anopportunity to review a registrant and accept or reject theregistration. Business intelligence information (e.g., generated by abusiness intelligence subsystem), scoring information (e.g., generatedby a scoring subsystem), and identification verification processes(e.g., using data matching algorithms, third-party data, and/orthird-party technology) may aid a client provider in determining whetherto accept or reject the registration. In addition, authentication of theregistrant (e.g., identity verification) may occur, such as bycross-checking received guarantor information with third-party datasources to perform identity verification (e.g., looking for one or morematches to a name, address, SSN, email, etc.) or alternatively offeringmultifactor authentication. If provider acceptance of the registrant isreceived 1308, the registered guarantor may be enabled to providecommunication and/or payment preferences. The communication preferencesmay be received and stored 1310. The communication preferences mayinclude, but are not limited to, preferences specifying manner, format,timing, and the like, for providing information to the guarantorconcerning the guarantor's account (including accounts linked to theguarantor's account for which the guarantor has assumed management). Thepayment preferences may also be received and stored 1312. The paymentpreferences may include, but are not limited to, preferences specifyingmanner, format, timing, and the like, for making payments on theguarantor's account. The payment preferences may enable contacting orotherwise interfacing with a payment gateway (e.g., third party) or afinancial institution of a preferred payment vehicle, which may generatean anonymous unique transaction identifier that can be used tofacilitate payment transactions. The anonymous unique transactionidentifier may be received 1314 and stored for use during paymentprocessing. The anonymous unique transaction identifier may link theguarantor's account to a previously specified financial services accountfor subsequent payment authorizations. The anonymous unique transactionidentifier may facilitate recurring transactions (using the specifiedfinancial services account) without storing PCI information, such asaccount numbers and credit card numbers. The anonymous uniquetransaction identifier may be, for example, a token that is generated bya third-party payment gateway and can be used to facilitate a paymentthrough that payment gateway.

FIG. 14 illustrates a graphical user interface 1400 to a private paymentportal subsystem, according to one embodiment. The graphical userinterface 1400 provides input fields and functionality for a firstguarantor to request that a second guarantor manage the account of thefirst guarantor. For example, an individual may want to request his/herspouse to manage the individual's account. In the illustrated graphicaluser interface 1400 of FIG. 14, the first guarantor can provideinformation for the second guarantor to whom the first guarantor wishesto assign management of the first guarantor's account. The userinterface 1400 requests personally identifiable information (e.g., firstname, last name, all or a portion of an ID number such as a SSN, andemail address) of the manager guarantor to aid in ensuring thatguarantors send manage requests only to other personally knownguarantors.

As can be appreciated, in other embodiments, a graphical user interfacemay provide input fields and functionality for a first guarantor torequest managerial rights over an account of a second guarantor. Forexample, an individual may want to request to manage his/her spouse'saccount. The first guarantor can provide information for the secondguarantor whose account the first guarantor wishes to manage. Again, theuser interface may collect personally identifiable information of theguarantor to be managed (e.g., name, user ID, and/or last four digits ofSSN) to aid in ensuring that guarantors send manage requests only toother personally known guarantors. An electronic notification of boththe linking request and the linking acceptance may be sent to bothguarantors to ensure they both are aware of and accept the obligationsimposed and the permissions granted in the linked (i.e., managed)account arrangement. The electronic notifications may aid in complyingwith internal client provider policies and/or external regulations(e.g., HIPAA).

FIG. 15 is a flow diagram of a method 1500 of linking guarantoraccounts, according to one embodiment. A request from a guarantor A(e.g., a first guarantor) is received 1502 to link guarantor A's accountto the account of guarantor B (e.g., a second guarantor). The requestmay be a request to be managed (e.g., for guarantor B to manageguarantor A's account) or a request to manage (e.g., for guarantor A tomanage guarantor B's account). A request to be managed may includeauthorization to release PHI and/or personal account information of therequesting guarantor. The authorization may comply with internal clientprovider policies and/or external regulations (e.g., HIPAA). A notice ofthe request is created 1504 and communicated to guarantor B. Theaccounts of guarantor A and/or guarantor B may be populated 1506 to alsogive notice of the outstanding manage request. An acceptance of therequest may be provided and received 1508. The acceptance of a requestto manage (e.g., a request by guarantor A to manage guarantor B'saccount) may include authorization to release PHI and/or personalaccount information to the manager guarantor.

If the manage request is accepted, account information, including, forexample, specific clinical visit information, for both the managedguarantor and the manager guarantor is provided 1510 in the account ofthe manager guarantor. In the case of a request to be managed, theaccount information for guarantor A is provided 1510 in the account forguarantor B. In the case of a request to manage, the account informationfor guarantor B is provided 1510 in the account for guarantor A. Linkingaccounts may include resetting 1512 a managed guarantor's payment datato match the manager guarantor's payment date. With the accountssuccessfully linked, the visit data, charge data, and balance data forthe managed guarantor are combined into the account of the managerguarantor and otherwise consolidated 1514 for purposes of presentment ofstatements and/or financing plans. For example, the manager guarantorcan view visit information of the managed guarantor's account. Anelectronic statement and/or account balance of the manager guarantorwould reflect charges for visits of the managed guarantor. For example,even if the manager guarantor does not have current visits for thestatement period, if the managed guarantor has a current visit duringthe statement period then an electronic statement would be generated forthe manager guarantor reflecting the visit charges of only the managedguarantor.

FIG. 16 is a flow diagram of a method 1600 of severing previously linkedguarantor accounts, according to one embodiment. A severing option isprovided 1602. The severing option may be an electronic link that can beclicked on to indicate a desire to sever linked accounts. The severingoption may be presented to the manager guarantor and/or the managedguarantor. Input indicating a desire to sever the link is received 1604.To sever linked accounts, in response to a received 1604 indication, themanaged guarantor's non-financial visit data and/or account data ispurged 1606 from the manager guarantor's account. The previous managerguarantor is prohibited from seeing any of the PHI or any otherinformation about the previously managed guarantor's accounts, whichprotects a managed guarantor should they decide to sever. As an example,all information about the managed user's accounts except specificinformation directly tied to the payment (e.g., date, amount, andaccount number) may be purged 1606. However, historic paymenttransaction data for previously linked account(s) continues to beprovided 1608 in the previous manager guarantor's account. Accordingly,the previous manager guarantor can access and view the historictransaction data to understand and account for historical payments madeto manage the previously managed account. When accessing accountinformation, the previous manager guarantor is presented 1610 with theoriginal charges of the previously managed guarantor (and which werepaid for by the previous manager guarantor), but the current balance ofthe previous manager guarantor reflects only the current balance owedfrom that guarantor's own visits. Any outstanding balances that remainon financing plans for visit charges not originally attributable to theprevious manager guarantor are unwound and presented 1612 to thepreviously managed guarantor as “new charges” on the previously managedguarantor's next periodic statement. These “new charges” may bepresented with payment options to be either paid in full, paid accordingto the preset financing plan established by the client provider, orconverted to a new financing plan configured by that guarantor inaccordance with the client provider's policies.

At the severing of an account, the previously managed guarantor may havean outstanding balance owed (not paid in full by previous managerguarantor). As noted above, a managed guarantor may continue to befinancially responsible for any unpaid visit charges, despite delegatingmanagement of account to another guarantor (manager guarantor).Accordingly, when accounts are severed, an originally responsibleguarantor continues to be financially responsible for any guaranteedvisit charges. Accordingly, a previously managed guarantor may bepresented 1612 the outstanding balance effectively as a new obligationand may be presented payment options (including financing) to pay thenew obligation (or outstanding balance). If the previously managedguarantor had (before linking of the accounts) configured a payment datepreference that was different from the previous manager's configuredpayment date, the previously managed guarantor's payment date may bereset 1614 to the previously managed guarantor's established preference.

FIG. 17 is a graphical user interface 1700 to a private payment portalsubsystem, according to another embodiment. The graphical user interface(GUI) 1700 presents an electronic statement 1702 of a manager guarantor.The GUI 1700 may present a permanent record of obligations as theyappeared on a statement date. The electronic statement that is presentedto the guarantor may include a guarantor's obligations owed topotentially two (or more) different entities. Specifically, a guarantormay have a portion of an open charges balance transferred to a new assetholder. As such, an obligation (e.g., account receivable) could be owedto the provider and an obligation (or a prior obligation from apreviously established financing plan) may be owed to a different assetholder.

FIG. 18 is a flow diagram of a method 1800 for presenting a statement orcharges, according to one embodiment. Visit data and/or visit chargesare extracted or otherwise received 1801 and an electronic statement iscompiled or otherwise generated for a guarantor. An electronic notice ofan electronic statement is sent 1802 to the guarantor and/or managerguarantor of the account. The electronic notice may be communicated viaa communication preference configured by the guarantor or the managerguarantor. For example, the electronic notice may be an SMS textmessage. As another example, the electronic notice may be an emailmessage. Upon logging in, the guarantor or manager guarantor may bepresented 1804 with an interactive overview (e.g., see FIG. 9) and anelectronic statement of aggregated charges, payments, and adjustmentsusing extracted data. If the statement is for a manager guarantor, thestatement can include visit charges for managed guarantors whoseaccounts are linked to the manager guarantor.

The electronic statement may serve primarily as an electronic record ofrequired financing disclosures (e.g., interest assessments, paymentsreceived, etc.) to meet regulatory requirements. The electronicstatement may be provided, for example, in a PDF format. The interactiveoverview may be an interactive “statement” of charges that dynamicallychanges with user interaction. When a guarantor first logs in afterreceiving an electronic notice that a statement is ready, theinteractive overview data may match or closely match the electronicstatement and reflect, for example, a presumption that the preset orstandard payment configuration for new charges will likely be utilizedby the guarantor. If the guarantor elects instead to reconfigure thefinancing plan or make a prompt payment on new charges, the interactiveoverview data can change (e.g., the current amount due and/or amount tobe auto debited will rise or fall accordingly) as soon as that electionis saved. If the interactive overview changes according to an action ofa guarantor, the interactive overview may be out of sync with thestatement. But the next monthly statement may capture the actions takenduring this period and reflect balances, charges, interest assessments,discounts, fees, payments, and adjustment, accordingly.

Dispute functionality may also be provided 1806 to enable a guarantor todispute particular visit charges appearing on the electronic statement.The dispute functionality may suspend 1808 the status of a disputedcharge or otherwise temporarily remove the disputed charge from theaccount balance and/or the current statement until resolution of thedispute. In other words, the amount for a disputed charge may besubtracted from a current amount owed. Accordingly, the balance and/orcurrent amount owed that are reflected on the electronic statement canbe impacted by actions of the guarantor. A dispute about a visit chargemay be automatically channeled to a work queue, such as a disputes workqueue, for processing by the client provider. A dispute record may begenerated and introduced to the disputes work queue. The disputes workqueue may facilitate tracking and/or processing of disputes and ensuringthat disputes are timely resolved by the client provider.

Although a specific visit can be disputed, other visits that comprise agiven statement period's charges are not impacted and continue to appearon the electronic statement, the interactive overview, and/or thecurrent balance. In other words, disputing a visit does not prevent aclient provider from collecting on non-disputed visits that comprise thecurrent visit charges (e.g., batch or bundle of business). A guarantorcould create a financing plan on a batch of current visits, subsequentlyhave additional charges be applied to a specific visit after it wasoriginally billed, and the set of charges for that specific visit couldbe challenged. The disputed visit could be taken offline effectivelywithout disrupting or impacting the rest of the visit charges within thefinancing plan.

Account matching functionality may also be provided 1810 to link anunmatched account with the client provider, as mentioned above withreference to the guarantor matching engine 1012 of FIG. 10. A guarantormay be aware of a visit that occurred during the statement period (suchas by receiving a paper billing statement from a billing system of theclient provider), and the visit and/or corresponding visit charges maynot appear in the electronic statement. The visit and/or correspondingvisit charges may belong to the current guarantor (or a currentlymanaged guarantor), but may reside in a different billing system of theclient provider from other visits and corresponding visit charges thatare properly reflected on the electronic statement. The account of theguarantor within the different billing system may be unmatched to theaccount of the guarantor associated with the electronic statement. Theaccount may be previously unmatched due to a variety of issues (e.g.,data input error, incomplete data, typographical error). Irrespective ofthe billing system from which the unmatched account originated, theaccount matching functionality that is provided 1810 enables theguarantor to locate the missing visit data and match the associatedbilling system account with the guarantor's account corresponding to theelectronic statement. Even for charges that a guarantor may not be awareof, matching logic may identify accounts in the billing system(s) thatshould be associated with a guarantor account record in the paymentmanagement system. The matching logic may determine the guarantoraccount those previously unmatched billing system accounts should beassociated with and can associate those unmatched billing systemaccounts to the appropriate guarantor account record in the paymentmanagement system. Once the unmatched account is matched to theguarantor's account, the interactive electronic statement may be updatedto reflect additional visit data. Once an unmatched billing systemaccount is associated with a guarantor account in the payment managementsystem (either through matching logic or if user manually links anotherwise orphan account), that association persists even though thebilling system itself may not recognize the relationship. In otherwords, the billing system may not be updated based on the matchingprocess. The billing system tracking remains independent of the paymentmanagement system tracking.

Payment options are also provided 1812 to the guarantor to make apayment on the balance shown on the electronic statement. As notedpreviously, the payment options may include:

-   -   Pay in full for new visits to potentially earn a prompt-pay        discount, based on choices and/or configured preferences of the        client provider and possibly subject to what is allowed by the        guarantor's insurance plan.    -   Customize a new financing plan to pay a new balance comprising        charges for visits from a current statement period, subject to        policies and preferences of the client provider.    -   Accept (e.g., by taking no action or affirmatively accepting)        preset financing terms for a multi-month financing plan at a        pre-established interest rate (e.g., a low or 0.0% interest        rate) as configured by the client provider.        Providing 1812 payment options may include receiving input for        making a payment in full. Providing 1812 payment options may        include receiving input specifying customized terms for a new        financing plan and comparing the customized terms to        preferences, constraints, stipulations, policies, and the like        of the client provider and/or external regulations. Selecting a        payment option may alter the amount due for new charges during        that statement period. For example, in the case where the        electronic statement is generated assuming the preset financing        option would be selected, customizing a financing plan or paying        new charges in full while receiving a prompt-pay discount may        alter the amount due. The interactive overview of the account        (e.g., see FIG. 9) may change on prospective items as a result        of guarantor interaction and payment selections. The next        periodic billing statement will reflect these new actions. In        other words, the amount a guarantor is expected to pay on a        received statement may change based on a payment option        selection that departs from an assumed payment option (e.g.,        preset financing terms or payment in full) used to generate the        electronic statement.

A payment on the account, for the electronic statement, may be processed1814. At any point, the guarantor (or manager guarantor) for whom theelectronic statement was generated may make a payment against a balanceowed. The payment may match a current amount due on the statement.Alternatively, the payment may be different from a current amount due.When the payment is different from the current amount due, rules mayspecify an order of applying payment to the current amount due. Thecurrent amount due may comprise payments for previouslyaccepted/configured financing plans as well as the current visitcharges. The payment may be applied to the oldest financing plans first.Or another ordering may be specified, according to preferences and/orsettings defined by the system, the client provider, and/or an assetholder. A posting file may be generated to inform the respective billingsystem(s) of which accounts or charges the payment should be applied.

FIG. 19 is a flow diagram of a method 1900 of receiving payment forhealthcare services, according to one embodiment. Input indicatingselection of a payment-in-full option may be received 1902. There may bea check 1904 for any predetermined prompt payment discounts or otherdiscounts offered by the client provider. The discounts offered maydepend on guarantor characteristics at one or more of a provider level,a guarantor level, and a visit level. Decisioning rules may determine agrouping of a guarantor based on the guarantor characteristics and maydefine any discounts offered for that grouping. The client provider mayconfigure such discounts, and they may be stored in a client-configureddatabase (e.g., within the datastore 121 of FIG. 1). If a prompt paymentdiscount (or other discount) is available, the guarantor may bepresented 1906 with the discount amount and/or terms. The guarantor mayalso be presented 1908 the total for the new visit charges net of thediscount.

Guarantor preferences may be checked to determine 1910 paymentpreferences for the guarantor. The payment preferences of the guarantormay include a payment method preference specifying a preferred mode ofpayment or payment vehicle (e.g., the guarantor's credit card, debitcard, bank account, or Health Savings Account). A financial transactionauthorization request is generated 1912. The transaction is processed1914 between the guarantor financial institution and the client providerfinancial institution. The processing 1914 may be facilitated and/orperformed by a payment gateway. Authorization for the transaction may begranted and thus received in response to the transaction authorizationrequest. Alternatively, a confirmation of a completed or otherwiseeffectuated transaction may be received, for example, directly from theguarantor and/or the client provider financial institution(s). Once thetransaction has been completed or otherwise effectuated, the billingsystem may be notified 1916 of the transaction. The notification mayoccur by generation of a transaction posting file that may betransmitted to the billing system. The transaction posting file mayinform the respective billing system(s) as to which specific accounts orcharges the payment should be applied.

FIG. 20 is a flow diagram of a method 2000 of receiving payment forhealthcare services, according to another embodiment. Input indicatingselection of guarantor-configured financing may be received 2002. Theremay be a check 2004 for rules, stipulations, or constraints specifyingparameters for financing plans that are authorized by the clientprovider. As an example, decisioning rules may group a guarantoraccording to guarantor characteristics at one or more of a providerlevel, a guarantor level, and a visit level. The decisioning rules mayalso specify authorized financing terms for guarantor-configuredfinancing options presented to a guarantor matching the characteristicsfor that grouping. The client provider may configure the decisioningrules and/or the authorized financing terms, and they may be stored in aclient-configured database (e.g., within the datastore 121 of FIG. 1).The guarantor requested-financing terms may also be received 2006 from aguarantor. The guarantor-requested financing terms may be compared toauthorized financing terms, and a best financing offer integrating theguarantor's request within the authorized financing terms is determinedand presented 2008 for approval by the guarantor. If the guarantorapproves, the amount for the first payment for the new financing plan issummed 2010 with the payment amount for previous outstanding financingplans for presentation to the guarantor.

Guarantor preferences may be checked to determine 2012 paymentpreferences for the guarantor. The payment preferences of the guarantormay include a payment method preference specifying a preferred mode ofpayment or payment vehicle (e.g., the guarantor's credit card, debitcard, bank account, or Health Savings Account). A financial transactionauthorization request is generated 2014. The transaction is processed2016 between the guarantor financial institution and the client providerfinancial institution. The processing 2016 may be facilitated and/orperformed by a payment gateway. Authorization for the transaction may begranted and thus received in response to the transaction authorizationrequest. Alternatively, confirmation of the transaction may be received.Once the transaction has been completed or otherwise effectuated, thebilling system may be notified 2018 of the transaction. The notificationmay occur by generation of a transaction posting file that may betransmitted to the billing system. The transaction posting file mayinform the respective billing system(s) as to which specific accounts orcharges the payment should be applied.

FIG. 21 is a flow diagram of a method 2100 of receiving payment forhealthcare services, according to yet another embodiment. Inputindicating selection or acceptance of pre-set financing option may bereceived 2102. In some embodiments, acceptance may be received bypassage of time and/or lack of selection of another payment option. Inother words, if the guarantor does not select a payment option by agiven date (e.g., a due date of the statement), the pre-set financingoption may be automatically presumed to be accepted.

There may be a check 2104 for rules, stipulations, or constraints,specifying pre-set financing terms configured by the client providerand/or the present or eventual asset holder. The rules may definegroupings or categories of guarantors based on criteria at any one ormore of a provider level, a guarantor level, and/or a visit level, tospecify different pre-set financing terms for each grouping or category.For example, decisioning rules may be defined at a provider level tospecify a first set of pre-set financing terms for guarantors havingcharges incurred from (or amounts or balances owed to a first providerand to specify to a second set of pre-set financing terms for chargesincurred from (or amounts or balances owed to) a second provider. Asanother example, decisioning rules may be defined at a guarantor levelto specify a first set of pre-set financing terms for guarantors havinga first set of attributes (e.g., a PTP score, a credit score, anestimated household income level, an estimated household size, and anability to pay (ATP) score) and to specify a second set of pre-setfinancing terms for guarantors having a second set of attributes. Asstill another example, decisioning rules may be defined at a visit levelto specify a first set of pre-set financing terms for a guarantoraccording to characteristics of visit charges (or corresponding visits)included in a current batch of open charges and/or open charges balanceof the guarantor. The decisioning rules may specify a second set ofpre-set financing terms for a guarantor for a guarantor having visitcharges with different characteristics. The rules may be defined by aprovider or other asset holder (e.g., holder of title of an accountsreceivable asset that constitutes rights to collect payment for abalance, such as an open charges balance) to specify different financingplan parameters for different situations. The client provider or otherasset holder may configure such rules and corresponding financing planparameters and they may be stored in a client-configured database (e.g.,within the datastore 121 of FIG. 1).

The payment of the current period charges over the pre-set multiplenumber of periods at a pre-set interest rate may be calculated 2106,based on the pre-set financing terms. For example, the pre-set number ofperiods and/or preset interest rate may be based on client-configuredpreferences, for example, stored in a client-configured database (e.g.,in the datastore 121 of FIG. 1). In one embodiment, the terms of thefinancing plan of the pre-set financing option may be configured tocomply with a definition under law of a payment plan that is not subjectto more stringent regulatory requirements (e.g., presently four months).In other embodiments, the terms of the pre-set financing option may bedetermined according to decisioning rules. In other words, the terms ofthe pre-set financing option may vary depending on guarantorcharacteristics. The pre-set financing option may vary based onguarantor characteristics at one or more of a provider level, aguarantor level, and/or a visit level.

There may be a check 2106 for rules, stipulations, or constraints,specifying parameters for financing plans that are authorized by theclient provider. The rules may define groupings or categories ofguarantors based on criteria at any one or more of a provider level, aguarantor level, and/or a visit level, to specify different financingplan parameters for each grouping or category. For example, decisioningrules may be defined at a provider level to specify a first set offinancing plan parameters guarantors having charges incurred from (oramounts or balances owed to) a first provider and to specify to a secondset of financing plan parameters for charges incurred from (or amountsor balances owed to) a second provider. As another example, decisioningrules may be defined at a guarantor level to specify a first set offinancing plan parameters for guarantors having a first set ofattributes (e.g., a PTP score, a credit score, an estimated householdincome level, an estimated household size, and an ability to pay score)and to specify a second set of financing plan parameters for guarantorshaving a second set of attributes. As still another example, decisioningrules may be defined at a visit level to specify a first set offinancing plan parameters for a guarantor according to characteristicsof visit charges (or corresponding visits) included in a current batchof open charges and/or open charges balance of the guarantor. The rulesmay be defined by a provider or other present or eventual asset holder(e.g., holder of title of an accounts receivable asset that constitutesrights to collect payment for a balance, such as an open chargesbalance) to specify different financing plan parameters for differentsituations. The client provider or other asset holder may configure suchrules and corresponding financing plan parameters, and they may bestored in a client-configured database (e.g., within the datastore 121of FIG. 1). The calculated payment may be compared to authorizedfinancing terms and altered as necessary. The amount for the firstpayment for the new financing plan is summed 2108 with the paymentamount for previous outstanding financing plans for presentation to theguarantor.

Guarantor preferences may be checked to determine 2110 paymentpreferences for the guarantor. The payment preferences of the guarantormay include a payment method preference specifying a preferred mode ofpayment or payment vehicle (e.g., the guarantor's credit card, debitcard, bank account, or Health Savings Account). A financial transactionauthorization request is generated 2112. The transaction is processed2114 between the guarantor financial institution and the client providerfinancial institution. The processing 2114 may be facilitated and/orperformed by a payment gateway. Authorization for the transaction may begranted and thus received in response to the transaction authorizationrequest. Alternatively, confirmation of the transaction may be received.Once the transaction has been completed or otherwise effectuated, thebilling system may be notified 2116 of the transaction. The notificationmay occur by generation of a transaction posting file that may betransmitted to the billing system. The transaction posting file mayinform the respective billing system(s) as to which specific accounts orcharges the payment should be applied.

FIG. 22 is a diagram of a financing engine 1024 of a payment managementsystem, according to one embodiment. The financing engine 1024 mayinclude decisioning rules 2204, pre-determined payment options 2206, andan offer generator 2208. The pre-determined payment options 2206 mayinclude authorized financing terms 2212 for guarantor-configurablefinancing options and pre-set financing terms for pre-set financingoptions. The financing engine 1024 may present to a guarantor of one ormore visit charges one or more pre-determined payment options 2206 forpaying an open charges balance, receive a guarantor selection of one ofthe pre-determined payment options, and determine a payment amount basedon the selected one of the pre-determined payment options. Moreparticularly, the financing engine 1024 may provide a set of one or morepre-determined payment options 2206, including authorized financingterms 2212 and/or pre-set financing terms 2214, determined as describedbelow. By providing the pre-determined payment options, the financingengine 1024 enables payment flexibility for guarantors.

The decisioning rules 2204 may be configured by an asset holder of anopen charges balance that the guarantor is expected to pay. The assetholder may be a provider of the services, an operator of the paymentmanagement system, or a third party entity to which the open chargesbalance was transferred or will be transferred (e.g., by the balancebrokering engine in FIG. 10), upon finalizing terms of a financingconstruct with the guarantor. Each decisioning rule may specify criteriathat group a guarantor (e.g., into a classification or segment). Thecriteria may specify characteristics of the guarantor at one or more ofa provider level, a guarantor level, and a visit level. Each decisioningrule may also specify one or more pre-determined payment options arepresented to a guarantor. For example, the decisioning rule may specifyauthorized financing terms 2212, which the asset holder intends to applyto guarantors that satisfy the criteria of the decisioning rule.

The provider-level criteria consider guarantor characteristics relatingto a provider of services or otherwise associated with the visit chargesof the open charges balance. In other words, the provider-level criteriaconsider provider characteristics, such that the authorized financingterms of the guarantor-configured financing option depend on a visitprovider for the one or more visit charges. As an example, aprovider-level criteria may specify that the decisioning rule paymentoptions apply to the guarantor if the visit charges include charges froma particular provider. In this manner, guarantors owing payments to afirst provider (e.g., St. Luke's) may be grouped into a category andreceive a set of one or more corresponding pre-determined paymentoptions while guarantors owing payments to a second provider (e.g.,Intermountain Healthcare), may be grouped into a different category andreceive a different set of one or more corresponding pre-determinedpayment options.

The guarantor-level criteria consider guarantor characteristics specificto the given guarantor. Examples of types of guarantor-level criteriainclude, but are not limited to: a PTP score, a credit score, an incomeestimate, a size of household estimate. an ability to pay score, a totalamount presently owing to one or more providers, a location (e.g.,residence) of the guarantor, physical characteristics of the guarantor(e.g., height, weight, blood pressure), and a type of insurance held bya guarantor. Accordingly, a first guarantor having a first PTP score maybe presented different pre-determined payment options than a secondguarantor having a second PTP score that is different from the first PTPscore.

The visit-level criteria consider guarantor characteristics relating tovisits and/or visit charges of the open charges balance. Examples oftypes of visit-level criteria include, but are not limited to: a visitcharge amount, an open charges balance, an age of the open charges, alocation of the visit, and a visit benefit (e.g., a treatment provided)to a beneficiary of the visit.

As noted, the pre-determined payment options may include one or more ofauthorized financing terms 2212 for guarantor-configurable financingoptions and pre-set financing terms 2214 for pre-set financing options.The authorized financing terms 2212 and pre-set financing terms 2214 mayprovide for a variety of financing types, including open-endedinstallment loan financing, revolving open-ended credit financing, andclose-ended financing. For example, installment loan financing terms mayinclude an amortization of the open charges balance into multipleregular periodic payments. As another example, revolving open-endedcredit financing terms may simply specify a minimum payment amount due.

The authorized financing terms 2212 may provide allowable ranges intowhich guarantor-configured financing terms may fall. Guarantor-requestedfinancing terms 2250 received from a guarantor may be compared to theauthorized financing terms 2212 by the offer generator to generate afinancing offer for an open charges balance. The guarantor-requestedfinancing terms may include one or more of: a financing type (e.g.,installment loan type, revolving credit type), a desired number ofperiods for payment over which recurring payments will be made tocomplete payment of the open charges balance, a desired interest rate,an interest rate type, including a fixed interest rate or a variableinterest rate, a period payment amount; and a minimum payment amount.The authorized financing terms 2212 may indicate acceptable minimums,ranges, or otherwise authorized terms per the provider and/or assetholder. The authorized financings terms may include one or more of afinancing type (e.g., installment loan type, revolving credit type), aminimum payment amount, a maximum amortization period, a minimuminterest rate, an interest rate type (e.g., a fixed interest rate or avariable interest rate), interest rate tranches, an interest freeperiod, a credit limit for open charges, interest bearing ornon-interest bearing, a prompt payment discount, a charity (or hardship)discount, a pre-payment discount, and a self-pay discount.

The offer generator 2208 may compare guarantor characteristics tocriteria of the decisioning rules 2204 to determine an appropriate setof one or more pre-determined payment options, including correspondingauthorized financing terms and/or pre-set financing terms 2214. Theoffer generator 2208 may receive guarantor requested terms 2250, in thecase of guarantor-configurable payment options and compare those termsto the authorized financing terms 2212. Based on the decisioning rulesand any comparison to authorized financing terms 2214, the offergenerator 2208 generates an appropriate financing offer for theguarantor to finance the open charges balance.

FIG. 23 is a flow diagram of a method 2300 of brokering a balance,according to one embodiment. A guarantor selection requesting apre-determined financing option may be received 2302 indicating theguarantor desires to finance an open charges balance. The open chargesbalance may be determine by compiling one or more visit charges for aguarantor during a time period into a current batch of open charges andaggregating all the open charges to a balance. The guarantor'spropensity-to-pay (PTP) and ability-to-pay (ATP) attributes may bechecked 2304 or otherwise examined to determine a likelihood of the opencharges balance being paid by the guarantor. A determination 2306 may bemade to assess if the asset resulting from a financing plan is eligibleto be transferred. The determination 2306 may be based on criteriaestablished by the provider and/or criteria established by a potentialnew asset holder (transferee). If the determination 2306 is “No,” theopen charges balance is not transfer eligible, the open charges balancewill remain held by the provider and provider-configured decisioningattributes (e.g., decisioning rules) may be checked or otherwiseconsidered to determine financing options for presentation 2314 to theguarantor. If the determination 2306 is “Yes,” the open charges balanceis eligible for transfer, the open charges balance can be transferred toa new asset holder, such as an operator of the payment management systemor a third-party entity (such as a financial or lending institution).Decisioning attributes (e.g., decisioning rules) of the potential newasset holder may be checked 3212 or otherwise considered to determinefinancing options for presentation 2314 to the guarantor. Based onappropriate decisioning attributes, appropriate financing options arepresented 2314 to the guarantor for consideration. The financing options2314 may be presented to a client computing system, for example, over anetwork such as the Internet. The guarantor can select a financingoption and provide authorization or approval of the terms. The financingauthorization is received 2316 from the guarantor. An auto-payment isestablished 2318 according to the terms of the financing option.

If the open charges balance is remaining with the provider, theauto-payment is established 2318 to transfer funds from the guarantorbank account to the provider bank account. The financing plan terms arerecorded 2320 by the payment management system.

If the open charges balance is to be transferred, the auto-payment isestablished 2318 to transfer funds from the guarantor bank account tothe new asset holder bank account. In the case of a transferred asset,an asset purchase payment is routed 2330 from the new asset holder tothe provider (e.g., electronic transactions are effectuated). Also, aposting file is routed 2332 to the provider billing system tocommunicate satisfaction of the balance with respect to the providersystem (and thus assumption of the balance by the new asset holder). Thetransferred asset is booked 2334 or otherwise recorded to the accountingsystem of the new asset holder (e.g., a system of record, a G/L, and/orthe like).

FIG. 24 is a diagram of a payment management system 102 brokering abalance, according to one embodiment. The payment management system 102may include a balance brokering engine 1026 that may implement themethod of FIG. 23 to transfer an open charges balance from a provider2410 to a new asset holder 2412. The payment management system 102 mayenable configuration of asset sale criteria 2402 to determine whether anopen charges balance is eligible for transfer. The balance brokeringengine considers decisioning rules 2404 to present financing options tothe guarantor 2414 of the open charges balance. The decisioning rulesmay be configured by the provider 2410 or the new asset holder 2412 asappropriate. If the open charges balance is transferable, and if theguarantor 2414 accepts a financing option, the balance brokering enginecan effectuate transfer of the asset to the new asset holder 2412. Thepayment management system 102 may communicate with the provider 2410,the new asset holder 2412, and the guarantor 2414 over a network 115,such as the Internet. The payment management system 102 may effectuateelectronic transactions over the network 115. A payment gateway 2420 mayfacilitate electronic transactions to transfer the asset to the newasset holder.

After an asset (e.g., open charges balance) is transferred to the newasset holder 2412, charges for a subsequent period are aggregated to anew open charges balance and can be used as a basis for a new assetdecisioning/brokering by the balance brokering engine 1026. As anexample, January's visits of $200 may be eligible for a purchase by thenew asset holder 2412 and may be transferred to a new system of recordof the new asset holder 2412, according to pre-arranged asset purchaseterms (e.g. 5% discount and non-recourse). February's visits of $1000are also eligible for asset transfer, but the larger balance may warranta steeper discount or move the asset to a full recourse model (e.g. 10%discount and full recourse back to the provider in the event of aguarantor default) held by yet another asset holder. In March, theguarantor 2414 may tally $100K in charges due to birth of prematurebaby. This balance may not qualify for asset transfer. Instead, theterms of the provider 2410 are offered and the payment management system102 may simply remain a servicer of the account of the guarantor 2414.The guarantor's statement in April may show any new charges for thatmonth, plus an amount due to the new asset holder 2412 for the Januaryloan and an amount due to the second new asset holder for the Februaryloan, and the amount due to the provider 2410 for the March loan plusthe amount due for April charges. All of the amounts due for the severalfinancings may be summed to one debit against the guarantor's bankaccount and the payment management system 102 may split the paymentbetween the various entities (provider 2410 and new asset holder 2412)and allocate appropriate amounts to interest and principle.

EXAMPLE EMBODIMENTS

Some examples of embodiments of adaptive natural language interfaces andother adaptive output systems are provided below.

Example 1

A system for managing payments for services, comprising: one or moreprocessors; a memory in electrical communication with the one or moreprocessors to store first visit data tracked by a first billing system,the first visit data specifying one or more visit charges incurredduring a time period, each of the one or more visit charges incurred fora visit; a visits engine to compile the one or more visit charges into acurrent batch of open charges and generate an open charges balance byaggregating all open charges of the current batch of open charges; abalance brokering engine to evaluate the open charges balance based onasset sales criteria for determining whether the open charges balanceshould be transferred from the first billing system to a new system ofrecord and effectuate electronic transactions to transfer title of anaccounts receivable asset that constitutes rights to collect payment forthe open charges balance, including payment for the current batch ofopen charges, to the new system of record, if the asset sales criteriaare met; and wherein the system tracks the open charges balance,including payments to pay the one or more visit charges and othertransactions relating to the open charges balance, wherein the systemtracks the open charges balance separate from the first billing systemand tracks transactions tracked in the first billing system that pertainto the one or more visit charges.

Example 2

The system of Example 1, further comprising an extraction engine toextract the first visit data from the first billing system and togenerate a single longitudinal portrayal including the first visit dataand the second visit data.

Example 3

The system of Example 1, further comprising a payment clearance androuting engine to interface with a payment gateway to effectuateelectronic transactions to transfer the title of the accounts receivableasset.

Example 4

The system of Example 1, wherein the balance brokering engine isconfigured to effectuate the transactions to transfer title of theaccounts receivable asset to the new system of record by: debiting theopen charges balance from a financial institution account associatedwith the new system of record; crediting the open charges balance to afinancial institution account associated with the first billing system.

Example 5

The system of Example 1, wherein the asset sales criteria are defined bya provider associated with the first billing system.

Example 6

The system of Example 1, wherein the asset sales criteria are defined bya potential new asset holder associated with the new system of record towhich the open charges balance is transferred if the asset salescriteria are met.

Example 7

The system of Example 1, wherein the system is the new system of record.

Example 8

The system of Example 1, wherein the new system of record is athird-party system, remote from the payment management system andcoupled to the system management system over a communication network.

Example 9

A computer-implemented method for managing payments for a benefit, suchas a product or service, the method comprising: receiving, at a paymentmanagement system comprising one or more computing devices, visit databeing tracked by a first billing system and specifying one or more visitcharges, each of the one or more visit charges including one or morecharges incurred for a visit during a time period; compiling the one ormore visit charges for the time period into a current batch of opencharges; generating an open charges balance by aggregating all opencharges of the current batch of open charges; evaluating the opencharges balance, by the payment management system, based on one or morepre-defined asset sales criteria to determine whether the open chargesbalance should be transferred to a new system of record; if the one ormore asset sales criteria are met, automatically effectuating by thepayment management system electronic transactions to transfer title ofan accounts receivable asset that constitutes all rights to collectpayment for the open charges balance, including payment for the currentbatch of open charges, to an entity associated with the new system ofrecord; and tracking, at the payment management system, transactionsrelating to the open charges balance, including payments to pay thecurrent batch of open charges, the tracking being separate from thefirst billing system.

Example 10

The method of Example 9, wherein effectuating transactions to transfertitle of the accounts receivable asset to the new system of recordcomprises communicating a transaction request to a payment gateway torequest the payment gateway: debiting the open charges balance from afinancial institution account associated with the new system of record;crediting the open charges balance to a financial institution accountassociated with the first billing system.

Example 11

The method of Example 9, further comprising: compiling into the currentbatch of open charges one or more additional transactions that relate tothe one or more visit charges, the one or more additional transactionsincluding additional transactions that adjust at least one of the one ormore visit charges in the current batch of open charges adjust a grossbatch balance that is a sum of the one or more visit charges, whereingenerating the open charges balance comprises aggregating all opencharges of the current batch of open charges, including the one or moreadditional transactions.

Example 12

The method of Example 11, wherein the additional transactions includeone or more of: an interest charge based on an amount owing for one ormore past open charges balances; a system of record fee; a payment froman insurance provider to be deducted in aggregating all the open chargesof the current batch of open charges; a provider adjustment to a visitcharge; and a removal of a disputed visit charge.

Example 13

The method of Example 11, wherein effectuating transactions to transfertitle of the accounts receivable asset to the new system of recordcomprises communicating a transaction request to a payment gateway torequest the payment gateway: debiting each of the current open chargesfrom a financial institution account associated with the new system ofrecord; crediting each of the one or more open charges to a financialinstitution account associated with the first billing system with.

Example 14

The method of Example 9, wherein the one or more asset sales criteriainclude system criteria that are pre-defined by a payment managementsystem administrator.

Example 15

The method of Example 14, wherein the system criteria include apropensity to pay score.

Example 16

The method of Example 9, wherein the one or more asset sales criteriainclude provider criteria that are pre-defined by a provider of a visitof the one or more visit charges.

Example 17

The method of Example 16, further comprising receiving, at the paymentmanagement system the one or more provider criteria.

Example 18

The method of Example 9, wherein the asset sales criteria are defined bya potential new asset holder associated with the new system of record towhich the open charges balance is transferred if the asset salescriteria are met.

Example 19

The method of Example 9, further comprising: receiving, at the paymentmanagement system, data specifying a payment vehicle for paying apayment amount; communicating a transaction request to a payment gatewayto request the payment gateway debit payment funds in the payment amountfrom a payor financial institution associated with the payment vehicleand credit at least a portion of the payment funds to a payee financialinstitution associated with the new system of record, in payment towardthe batch balance; and communicating an electronic posting file tonotify the new system of record of transfer of at least at portion ofthe payment funds in payment toward the open charges balance.

Example 20

The method of Example 19, further comprising: receiving at the one ormore computing devices payment option input specifying providerpre-determined payment options; receiving at the one or more computingdevices a selection of one of the provider pre-determined paymentoptions; and determining the payment amount based on the selected one ofthe provider pre-determined payment options.

Example 21

The method of Example 9, further comprising: receiving, at the paymentmanagement system, second visit data being tracked in a second billingsystem and specifying one or more second visit charges, each of the oneor more second visit charges including one or more charges incurred fora visit during the time period; and compiling the one or more secondvisit charges for the time period into the current batch of opencharges, wherein generating the open charges balance comprisesaggregating all open charges of the current batch of open charges,including the one or more second visit charges, thereby aggregatingvisit charges for the time period that are tracked in multiple billingsystems.

Example 22

The method of Example 21, wherein the second visit data is received fromthe second billing system, wherein the second billing system is remotefrom the one or more computing devices.

Example 23

The method of Example 21, wherein the one or more visit charges includesa visit charge for a first visit of a beneficiary, wherein the one ormore second visit charges includes a visit charge for a second visit ofa second beneficiary.

Example 24

The method of Example 9, wherein the time period comprises an initialtime period and the current batch of open charges comprises a firstbatch of open charges, the method further comprising: receiving, at thepayment management system, second visit data being tracked in the firstbilling system and specifying one or more second visit charges, each ofthe one or more second visit charges including one or more chargesincurred for a visit during a second time period distinct from to theinitial time period; compiling the one or more second visit charges forthe second time period into a second batch of open charges; generating asecond open charges balance by aggregating all open charges of thesecond batch of open charges; wherein the second open charges balance ismaintained separate from the first open charges balance; evaluating thesecond open charges balance, by the payment management system, based onthe asset sales to determine whether the second open balance should betransferred to a new system of record; if the asset sales criteria arenot met, maintaining title of an accounts receivable asset thatconstitutes all rights to collect payment for the second open chargesbalance, including payment for the second batch of open charges, at thefirst billing system, wherein the first billing system remains as asystem of record; and tracking, at the payment management system,transactions relating to the second open charges balance, includingpayments to pay the second batch of open charges, the tracking beingseparate from the first billing system, the tracking includingtransactions tracked in the first billing system that pertain to the oneor more second visit charges.

Example 25

The method of Example 24, wherein a visit charge of the first visit dataspecifies a charge for a first visit of a beneficiary, wherein a visitcharge of the second visit data specifies a charge for a second visit ofa second beneficiary.

Example 26

The method of Example 24, wherein the first visit is a first healthcarevisit, the second visit is a second healthcare visit, and thebeneficiary is a patient.

Example 27

The method of Example 24, wherein the first visit is a first healthcarevisit of a first beneficiary and the second visit is a second healthcarevisit of a second beneficiary.

Example 28

The method of Example 9, wherein the new system of record is the paymentmanagement system.

Example 29

The method of Example 9, wherein the new system of record is athird-party system, remote from the payment management system andcoupled to the payment management system over a communication network.

Example 30

A system for managing payments, comprising: one or more processors; amemory in electrical communication with the one or more processors tostore first visit data tracked by a first billing system, the firstvisit data specifying one or more visit charges incurred during a timeperiod, each of the one or more visit charges incurred for a visit; avisits engine to compile the one or more visit charges into a currentbatch of open charges and generate an open charges balance byaggregating all open charges of the current batch of open charges; afinancing engine to: present, to a guarantor of the one or more visitcharges, pre-determined payment options for paying the open chargesbalance, each of the pre-determined payment options including terms atleast partially defined by one of a present asset holder and a potentialasset holder of the open charges balance; receive, at the paymentmanagement system, a guarantor selection of one of the pre-determinedpayment options for paying the open charges balance; and determine apayment amount based on the selected one of the pre-determined paymentoptions.

Example 31

The system of Example 30, wherein the present asset holder is a providerof one or more visits of the of the current batch of visit charges.

Example 32

The system of Example 30, further comprising: a payment portal toreceive payment data specifying a payment vehicle for paying a paymentamount; and a payment and clearance routing engine to: transmit atransaction request to a payment gateway to request the payment gatewayto obtain funds in the payment amount from a payor financial institutionassociated with the payment vehicle, to transfer a first portion of thepayment funds to a payee financial institution associated with the firstpatient billing system, and to transfer a second portion of the paymentfunds to a payee financial institution associated with the secondpatient billing system; and communicate one or more electronic postingfiles to notify the first patient billing system of transfer of thefirst portion of the payment funds toward payment of the charge for thefirst visit and to notify the second patient billing system of transferof the second portion of the payment funds toward payment of the chargefor the second visit.

Example 33

The system of Example 30, wherein the system tracks the open chargesbalance, including payments to pay the one or more visit charges andother transactions relating to the open charges balance, wherein thesystem tracks the open charges balance separate from the first billingsystem and tracks transactions tracked in the first billing system thatpertain to the one or more visit charges.

Example 34

The system of Example 30, wherein the pre-determined payment optionsinclude a complete resolution option to make a single payment insatisfaction of the open charges balance, wherein if the guarantorselection of one of the provider pre-determined payment options selectsthe complete resolution option, then the financing engine determines thepayment amount by: checking for a pre-determined payment discountspecified as a term of the complete resolution option; and determiningthe payment amount as the open charges balance net of the prompt paymentdiscount.

Example 35

The system of Example 30, wherein the pre-determined payment optionsinclude a guarantor-configured financing option allowing the guarantorto request one or more financing terms, the guarantor-configuredfinancing option including authorized financing terms at least partiallydefined by the one of the present asset holder and the potential assetholder of the open charges balance, wherein if the guarantor selectionof one of the provider pre-determined payment options selects theguarantor-configured financing option, then the financing enginedetermines the payment amount by: receiving a guarantor request for oneor more financing terms for financing the open charges balance;comparing a guarantor requested financing term to the authorizedfinancing terms; generating an financing offer, based on the guarantorrequested terms and the authorized financing terms; and determining thepayment amount based on terms of the authorized offer of financing.

Example 36

The system of Example 35, wherein the financing engine determines theguarantor-configured financing option that is presented to the guarantorbased on decisioning rules configured by the one of the present assetholder and the potential asset holder of the open charges balance, eachdecisioning rule specifying authorized financing terms for a group ofone or more guarantors that satisfy criteria of the decisioning rule.

Example 37

The system of Example 30, wherein the provider pre-determined paymentoptions include a pre-set financing option including pre-set financingterms at least partially defined by the one of the present asset holderand the potential asset holder of the open charges, wherein, if theselection of one of the provider pre-determined payment options selectsthe pre-set financing option, then the financing engine determines thepayment amount by one of: determining a minimum payment amount incompliance with the terms of the pre-set financing option, if thepre-set financing option comprises open-ended credit financing; andamortizing the open charges balance into regular periodic payments,based on the pre-set financing terms, and determining the payment amountas a first regular periodic payment of the regular periodic payments, ifthe pre-set financing option comprises installment loan financing.

Example 38

The system of Example 37, wherein the pre-set financing terms of thepre-set financing option that is presented to the guarantor aredetermined based on decisioning rules configured by the one of thepresent asset holder and the potential asset holder of the open chargesbalance, each decisioning rule specifying the terms of the pre-setfinancing option for a group of one or more guarantors that satisfycriteria of the decisioning rule.

Example 39

The system of any of Examples 30-38, wherein the financing engine isconfigured to determine the payment amount by summing a current paymentamount with payments due for financing one or more prior open chargesbalances, the current payment amount being the payment amount determinedbased on the selected one of the pre-determined payment options for theopen charges balance of the current batch of open charges, the paymentsdue for financing one or more prior open charges balances eachdetermined based on a previously selected pre-determined payment optionfor a corresponding prior open charges balance.

Example 40

A computer-implemented method for managing payments, the methodcomprising: receiving, at a payment management system comprising one ormore computing devices, first visit data that is tracked by a firstbilling system and specifying one or more visit charges incurred duringa time period, each of the one or more visit charges including one ormore charges incurred for a visit; compiling the one or more visitcharges for the time period into a current batch of open charges;generating an open charges balance by aggregating all open charges ofthe current batch of open charges; presenting, to a guarantor of the oneor more visit charges, pre-determined payment options for paying theopen charges balance, each of the pre-determined payment optionsincluding terms at least partially defined by one of a present assetholder and an eventual asset holder of the open charges balance;receiving, at the payment management system, a guarantor selection ofone of the pre-determined payment options for paying the open chargesbalance; and determining a payment amount based on the selected one ofthe pre-determined payment options.

Example 41

The method of Example 40, wherein at least one of the one or more visitcharges comprises an estimate of costs for the visit in advance ofoccurrence of the visit.

Example 42

The method of Example 40, further comprising: receiving, at the paymentmanagement system, data specifying a payment vehicle for paying thepayment amount; communicating a transaction request to a payment gatewayto request the payment gateway to debit payment funds from a payorfinancial institution associated with the payment vehicle and to creditat least a portion of the payment funds to a payee financial institutionassociated with the first billing system in payment toward the opencharges balance; and communicating an electronic posting file to notifythe first billing system of transfer of at least a portion of thepayment funds in payment toward specific visit charges of the currentbatch of open charges.

Example 43

The method of Example 40, wherein the transaction request is also torequest the payment gateway to credit at least a portion of the paymentfunds to the payee financial institution associated with the firstbilling system in payment toward one or more prior open chargesbalances.

Example 44

The method of Example 40, wherein the transaction request is also torequest the payment gateway to credit at least a portion of the paymentfunds to the payee financial institution associated with the firstbilling system in payment toward only a past open charges balance.

Example 45

The method of Example 40, wherein the pre-determined payment options areat least partially configured by one or more of a present asset holderand an eventual asset holder of the open charges balance.

Example 46

The method of Example 45, wherein the present asset holder is a providerof one or more visits of the current batch of visit charges.

Example 47

The method of Example 40, wherein the pre-determined payment optionsinclude a complete resolution option to make a single payment insatisfaction of the open charges balance, wherein if the selection ofone of the provider pre-determined payment options selects the completeresolution option, then determining the payment amount comprises:checking for a pre-determined payment discount specified as a term ofthe complete resolution option, wherein presenting the predeterminedpayment options includes presenting such pre-determined prompt paymentdiscount; and determining the payment amount as the open charges balancenet of the prompt payment discount.

Example 48

The method of Example 47, wherein the payment discount varies accordingto a segmentation or grouping at one or more of a provider level, aguarantor level, and a visit level.

Example 49

The method of Example 47, wherein the payment discount comprises aprompt payment discount.

Example 50

The method of Example 40, wherein the pre-determined payment optionsinclude a guarantor-configured financing option allowing the guarantorto request one or more financing terms, the guarantor-configuredfinancing option including authorized financing terms at least partiallydefined by one of a present asset holder and an eventual asset holder ofthe open charges balance, wherein if the guarantor selection of one ofthe pre-determined payment options selects the guarantor-configuredfinancing option, then determining the payment amount comprises:receiving a guarantor request providing one or more guarantor requestedfinancing terms for financing the open charges balance; comparing theone or more guarantor requested financing terms to the authorizedfinancing terms; generating an authorized offer of financing, based onthe guarantor requested terms and the authorized financing terms; anddetermining the payment amount based on terms of the authorized offer offinancing.

Example 51

The method of Example 50, wherein the authorized offer providesinstallment loan financing terms, including an amortization of the opencharges balance into multiple regular periodic payments, and wherein thepayment amount is determined to be a first regular periodic paymentprovided by the amortization of the open charges balance.

Example 52

The method of Example 50, wherein the authorized offer providesopen-ended credit financing terms specifying a minimum payment amountdue, based on a percentage of the open charges balance, and wherein thepayment amount is determined to be the minimum payment amount.

Example 53

The method of Example 50, wherein the guarantor-requested financingterms include one or more of: a financing type, including an installmentloan type or a revolving credit type; a desired number of periods forpayment over which recurring payments will be made to complete paymentof the open charges balance; a desired interest rate; an interest ratetype, including a fixed interest rate or a variable interest rate; aperiod payment amount; and a minimum payment amount.

Example 54

The method of Example 50, wherein the authorized financings termscomprise one or more of: a financing type, including an installment loantype or a revolving credit type; a minimum payment amount; a maximumamortization period; a minimum interest rate; an interest rate type,including a fixed interest rate or a variable interest rate; interestrate tranches; an interest free period; a credit limit for open charges;interest bearing or non-interest bearing; a prompt payment discount; acharity (or hardship) discount; a pre-payment discount; and a self-paydiscount.

Example 55

The method of Example 50, wherein the guarantor-configured financingoption, including the authorized financing terms, that is presented tothe guarantor is determined based on decisioning rules configured by theone of the present asset holder and the eventual asset holder of theopen charges balance, each decisioning rule specifying authorizedfinancing terms for a group of one or more guarantors that satisfycriteria of the decisioning rule.

Example 56

The method of Example 55, wherein the criteria of each decisioning rulegroup the guarantor at one or more of a provider level, a guarantorlevel, and a visit level.

Example 57

The method of Example 55, wherein provider-level criteria of adecisioning rule group the guarantor according to one or more providercharacteristics, such that the authorized financing terms of theguarantor-configured financing option depend on a visit provider for theone or more visit charges.

Example 58

The method of Example 55, wherein provider-level criteria of adecisioning rule group the guarantor according to one or more providercharacteristics, such that a first set of authorized financing terms ispresented to a guarantor for visit charges incurred from visits to afirst provider and a second set of authorized financing terms ispresented for visit charges incurred from visits to a second provider.

Example 59

The method of Example 55, wherein guarantor-level criteria of adecisioning rule group the guarantor according to one or morecharacteristics of the guarantor, including but not limited to: apropensity to pay score; a credit score; an income estimate; a size ofhousehold estimate; an ability to pay score; a total amount presentlyowing to one or more providers; a location (e.g., residence) of theguarantor; a physical characteristics of the guarantor (e.g., height,weight, blood pressure); and a type of insurance held by a guarantor.

Example 60

The method of Example 55, wherein visit-level criteria of a decisioningrule group the guarantor according to one or more characteristics of theone or more visits, including but not limited to: a visit charge amount;an open charges balance; an age of the open charges; a location of thevisit; and a visit benefit to a beneficiary of the visit.

Example 61

The method of Example 40, wherein the pre-determined payment optionsinclude a pre-set financing option including pre-set financing terms atleast partially defined by one of a present asset holder and an eventualasset holder of the open charges, wherein, if the guarantor selection ofone of the pre-determined payment options selects the pre-set financingoption, then determining the payment amount comprises one of:determining a minimum payment amount in compliance with the terms of thepre-set financing option, if the pre-set financing option comprisesopen-ended credit financing; and amortizing the open charges balanceinto regular periodic payments, based on the pre-set financing terms,and determining the payment amount as a first regular periodic paymentof the regular periodic payments, if the pre-set financing optioncomprises installment loan financing.

Example 62

The method of Example 61, wherein the pre-set financing terms of thepre-set financing option include one or more of: a financing type,including an installment loan type or a revolving credit type; a numberof periods for payment over which recurring payments will be made tocomplete payment of the open charges balance; an interest rate; aninterest rate type, including a fixed interest rate or a variableinterest rate; a period payment amount; a minimum payment amount;interest rate tranches; an interest free period; a credit limit for opencharges; interest bearing or non-interest bearing; a prompt paymentdiscount; a charity (or hardship) discount; a pre-payment discount; anda self-pay discount.

Example 63

The method of Example 61, wherein the pre-set financing terms of thepre-set financing option that is presented to the guarantor aredetermined based on decisioning rules configured by the one of thepresent asset holder and eventual asset holder of the open chargesbalance, each decisioning rule specifying the terms of the pre-setfinancing option for a group of one or more guarantors that satisfycriteria of the decisioning rule.

Example 64

The method of Example 63, wherein the criteria of each decisioning rulegroup the guarantor at one or more of a provider level, a guarantorlevel, and a visit level.

Example 65

The method of Example 63, wherein provider-level criteria of adecisioning rule group the guarantor according to one or more providercharacteristics, such that the terms of the pre-set financing optiondepend on a visit provider for the one or more visit charges.

Example 66

The method of Example 63, wherein provider-level criteria of adecisioning rule group the guarantor according to one or more providercharacteristics, such that the pre-set financing option includes a firstset of terms for visit charges incurred from visits to a first providerand includes an alternate second set of terms is presented for visitcharges incurred from visits to a second provider.

Example 67

The method of Example 63, wherein the guarantor-level criteria of adecisioning rule group the guarantor according to one or morecharacteristics of the guarantor, including but not limited to: apropensity to pay score; a credit score; an income estimate; a size ofhousehold estimate; an ability to pay score; a total amount presentlyowing to one or more providers; a location (e.g., residence) of theguarantor; a physical characteristics of the guarantor (e.g., height,weight, blood pressure); and a type of insurance held by a guarantor.

Example 68

The method of Example 63, wherein visit-level criteria of a decisioningrule group the guarantor according to one or more characteristics of theone or more visits, including but not limited to: a visit charge amount;an open charges balance; an age of the open charges; a location of thevisit; and a visit benefit to a beneficiary of the visit.

Example 69

The method of any of Example 40-68, wherein determining the paymentamount further comprises summing a current payment amount with paymentsdue for financing one or more prior open charges balances, the currentpayment amount being the payment amount determined based on the selectedone of the pre-determined payment options for the open charges balanceof the current batch of open charges, the payments due for financing oneor more prior open charges balances each determined based on apreviously selected pre-determined payment option for a correspondingprior open charges balance of a prior batch of open charges.

Example 70

The method of Example 69, wherein each of the payments due for financingone or more prior open charges balances is determined according to anext regular periodic payment for an amortization of a prior opencharges balance for a previous time period:

Example 71

The method of Example 40, further comprising: receiving, at the paymentmanagement system from a computing device of the one of the presentasset holder and the eventual asset holder of the open charges balance,payment option input to at least partially define the terms of thepre-determined payment options.

Example 72

A computer-implemented method for managing payments, the methodcomprising: receiving, at a payment management system comprising one ormore computing devices, charge data specifying one or more charges;compiling the one or more charges into a current batch of open charges;generating an open charges balance by aggregating all open charges ofthe current batch of open charges; presenting to a guarantor of the oneor more charges pre-determined payment options for paying the opencharges balance, each of the pre-determined payment options includingterms at least partially defined by one of a present asset holder and apotential asset holder of the open charges balance; receiving, at thepayment management system, a guarantor selection of one of thepre-determined payment options for paying the open charges balance; anddetermining a payment amount based on the selected one of the providerpre-determined payment options.

Example 73

The method of Example 72, wherein at least one of the one or morecharges comprises an estimate of a charge for a benefit to occur.

Example 74

The method of Example 73, wherein the benefit is to occur during afuture time period.

Example 75

The method of Example 72, wherein the pre-determined payment optionsinclude a guarantor-configured financing option allowing the guarantorto request one or more financing terms, the guarantor-configuredfinancing option including authorized financing terms at least partiallydefined by one of a present asset holder and a potential asset holder ofthe open charges balance, wherein if the selection of one of thepre-determined payment options selects the guarantor-configuredfinancing option, then determining the payment amount comprises:receiving a guarantor request for one or more financing terms forfinancing the open charges balance; comparing a guarantor requestedfinancing term to the authorized financing terms; generating anauthorized offer of financing, based on the guarantor requested termsand the authorized financing terms; and determining the payment amountbased on terms of the authorized offer of financing.

Example 76

The method of Example 75, wherein the guarantor-configured financingoption that is presented to the guarantor is determined based ondecisioning rules configured by the one of the present asset holder andthe potential asset holder of the open charges balance, each decisioningrule specifying authorized financing terms for a group of one or moreguarantors that satisfy criteria of the decisioning rule.

Example 77

The method of Example 72, wherein the pre-determined payment optionsinclude a pre-set financing option including pre-set financing terms atleast partially defined by one of a present asset holder and an eventualasset holder of the open charges, wherein, if the guarantor selection ofone of the pre-determined payment options selects the pre-set financingoption, then determining the payment amount comprises one of:determining a minimum payment amount in compliance with the terms of thepre-set financing option, if the pre-set financing option comprisesopen-ended credit financing; and amortizing the open charges balanceinto regular periodic payments, based on the pre-set financing terms,and determining the payment amount as a first regular periodic paymentof the regular periodic payments, if the pre-set financing optioncomprises installment loan financing.

Example 78

The method of Example 77, wherein the pre-set financing terms of thepre-set financing option that is presented to the guarantor aredetermined based on decisioning rules configured by the one of thepresent asset holder and the potential asset holder of the open chargesbalance, each decisioning rule specifying the terms of the pre-setfinancing option for a group of one or more guarantors that satisfycriteria of the decisioning rule.

Example 79

A system for managing payments for healthcare services, comprising: oneor more processors; a memory in electrical communication with the one ormore processors, the memory to store historical healthcare dataincluding healthcare transaction data tracked by a first billing system,the historical healthcare data pertaining to one or more guarantors; ascoring engine configured to extract propensity-to-pay (“PTP”)characteristics from the historical healthcare data, including PTPcharacteristics of the one or more guarantors, and calculate a PTPmetric for a guarantor based on PTP characteristics of the guarantorextracted from the historical healthcare data, wherein the PTP metricindicates a likelihood that the guarantor will pay for visit charges forhealthcare visits.

Example 80

The system of Example 79, wherein the PTP metric comprises a PTP score.

Example 81

The system of Example 80, wherein the scoring engine comprises aplurality of calculation engines, each configured to calculate arespective type of PTP score for a guarantor.

Example 82

The system of Example 81, wherein the plurality of calculation enginesdiffer with respect to one or more of a weighting and a combination ofalgorithms used to calculate a PTP score.

Example 83

The system of Example 79, wherein the PTP metric is a group identifierthat groups a guarantor into a group having an associatedpropensity-to-pay a visit charge for a healthcare visit.

Example 84

The system of Example 79, further comprising: a staging module todetermine a current stage of an account record of the guarantor, basedon the historical healthcare data, wherein the scoring engine calculatesthe PTP metric for the guarantor based on the stage of the accountrecord of the guarantor.

Example 85

The system of Example 86, wherein the staging module comprises a triggerengine configured to implement one or more triggered actions in responseto one or more of: assigning a stage to an account record; updating datapertaining to an account record; and a request for updated stageassignment information.

Example 86

The system of Example 79, the memory to further store first visit datathat is tracked by a first billing system and specifying one or morevisit charges incurred during a time period, each of the one or morevisit charges incurred for a visit, the system further comprising: avisits engine to aggregate, collect, or compile the one or more visitcharges into a current batch of open charges and generate an opencharges balance by aggregating all open charges of the current batch ofopen charges, wherein the scoring engine calculates the PTP metric forthe guarantor with respect to the open charges balance, such that thePTP metric indicates a likelihood that the guarantor will pay for theopen charges balance.

Example 87

The system of Example 86, further comprising: a financing engine to:present, to a guarantor of the one or more visit charges, pre-determinedpayment options for paying the open charges balance, each of thepre-determined payment options including terms at least partiallydefined by an asset holder of the open charges balance; receive, at thepayment management system, a guarantor selection of one of thepre-determined payment options for paying the open charges balance; anddetermine a payment amount based on the guarantor selected one of thepre-determined payment options.

Example 88

The system of Example 87, wherein each of the pre-determined paymentoptions include one or more terms defined by one of a present assetholder and an eventual asset holder of the open charges balance, whereinthe one or more terms depend on the PTP score of the guarantor.

Example 89

The system of Example 79, wherein the historical healthcare dataincludes healthcare transaction data tracked by a second billing system.

Example 90

The system of Example 79, the memory further to store credit reportingdata from one or more third party credit reporting sources, wherein thescoring engine calculates the PTP metric for the guarantor based on boththe PTP characteristics and the credit reporting data.

Example 91

The system Example 90, wherein the scoring engine is configured toextract an ability-to-pay (ATP) metric from the credit reporting data,and wherein the scoring engine calculates the PTP metric based on thePTP characteristics and the ATP metric.

Example 92

The system of Example 91, further comprising: a charity evaluationmodule configured to calculate a charity score for a guarantor based onthe PTP metric and the ATP metric.

Example 93

A computer-implemented method for managing payments for healthcareservices, the method comprising: aggregating, compiling or collecting,at a payment management system comprising one or more computing devices,historical healthcare data including healthcare transaction data trackedby a first billing system, the historical healthcare data pertaining tohealthcare visits of patients, whose visit charges are guaranteed by oneor more guarantors; extracting propensity-to-pay (“PTP”) characteristicsfrom the historical healthcare data, including PTP characteristics ofthe one or more guarantors; calculating a PTP metric for a firstguarantor of the one or more guarantors based on PTP characteristics ofthe first guarantor extracted from the historical healthcare data, thePTP metric indicating a likelihood that the first guarantor will pay forvisit charges for healthcare visits.

Example 94

The method of Example 93, wherein the healthcare transaction dataincludes billing transaction records, payment transaction records,and/or financing plan records associated with an account record of oneor more of the first guarantor and a first patient associated with thefirst guarantor, the account record maintained by the payment managementsystem.

Example 95

The method of Example 93, wherein the healthcare transaction dataincludes billing transaction records, payment transaction records,and/or financing plan records associated with visit charges of a patientassociated with the first guarantor.

Example 96

The method of Example 95, wherein the patient is the first guarantor.

Example 97

The method of Example 93, wherein the healthcare transaction dataincludes healthcare transaction action data for a second guarantor whoseaccount record is linked to the account record of the first guarantor.

Example 98

The method of Example 97, further comprising calculating a PTP metricfor the second guarantor based on PTP characteristics of the secondguarantor extracted from the historical healthcare data, the PTP metricindicating a likelihood that the second guarantor will pay for visitcharges.

Example 99

The method of Example 93, wherein the PTP metric is calculated based onPTP characteristics of the first guarantor that are inferred from PTPcharacteristics of one or more different guarantors of the one or moreguarantors that are calculated as being similar to the first guarantor.

Example 100

The method of Example 93, wherein the historical healthcare dataincludes healthcare condition data, including information pertaining toa healthcare condition of a patient associated with the guarantor.

Example 101

The method of Example 100, wherein the healthcare condition dataincludes one or more of diagnoses, disease conditions, chronic healthcondition(s), degenerative conditions.

Example 102

The method of Example 101, wherein the healthcare condition data isderived at least partially from billing transaction information includedin the healthcare transaction data tracked by the first billing system,the billing transaction information including one or more of treatmentcodes and diagnostic codes.

Example 103

The method of Example 101, wherein the healthcare condition data isderived at least partially from healthcare records of the patientmaintained by a healthcare service provider associated with the firstbilling system and providing healthcare services to the patient.

Example 104

The method of Example 93, wherein the historical healthcare dataincludes healthcare transaction data tracked by a second billing system.

Example 105

The method of Example 93, wherein the historical healthcare dataincludes healthcare transaction data tracked by a plurality of billingsystems in addition to the first billing system.

Example 106

The method of c Example 93, further comprising: receiving creditreporting data from one or more third-party credit reporting sources;calculating the PTP metric for the guarantor based on both the PTPcharacteristics and the credit reporting data.

Example 107

The method of Example 106, wherein the credit reporting data is reportedto the one or more third-party credit reporting sources by third-partycredit grantors, the credit reporting data including one or more of:types of credit extended to the guarantor; a length of time theguarantor's credit accounts have been open; timeliness of guarantorpayments to lenders; amount of credit extended to the guarantor; whethernew sources of credit are being actively sought by the guarantor; one ormore credit scores of the guarantor, each credit score summarizingcredit risk of the guarantor; a net worth estimate; an income estimate;and a size of household estimate.

Example 108

The method of Example 107, wherein the one or more credit scores includeone or more of a general credit score.

Example 109

The method of claim Example 108, wherein the general credit score is aFICO score.

Example 110

The method of Example 108, wherein the one or more credit scores includeone or more industry-specific credit scores, including but not limitedto credit scores of: the telecommunications industry; the healthcareindustry; and the retail industry.

Example 111

The method of Example 93, wherein the PTP characteristics include one ormore of: an average time to payment for healthcare transactions; latepayments; payment amounts; insurance coverage; copayments; flexiblespending account activity (e.g., estimated remaining balance);healthcare spending account activity; financing plan history (e.g.,whether the patient and/or guarantor(s) have used a financing plan topay for services and/or whether the payments were made in a timelymanner); a total amount presently owed to a provider; prior bad debtcharge-offs; prior hardship program assistance (charity); time periodsbetween transactions; and dispute history.

Example 112

The method of Example 93, further comprising: receiving, at a paymentmanagement system, first visit data that is tracked by a first billingsystem and that specifies one or more visit charges each incurred for avisit to a healthcare provider, wherein the PTP score for the guarantoris calculated for a visit charge of the one or more visit charges thatis guaranteed by the guarantor.

Example 113

The method of Example 93, further comprising: receiving, at a paymentmanagement system, an estimate of one or more visit charges for a visitto a healthcare provider, wherein the PTP score for the guarantor iscalculated for the estimate of one or more visit charges.

Example 114

The method of Example 93, further comprising: receiving, at a paymentmanagement system, first visit data that is tracked by a first billingsystem and that specifies one or more visit charges incurred during atime period for a visit to a healthcare provider, each of the one ormore visit charges guaranteed by the guarantor; compiling the one ormore visit charges for the time period into a current batch of opencharges; and generating an open charges balance by aggregating all opencharges of the current batch of open charges, wherein the PTP metric forthe guarantor is calculated for the open charges balance.

Example 115

The method of Example 114, wherein the PTP metric comprises a PTP score.

Example 116

The method of Example 115, wherein the PTP score for the guarantor iscalculated for the open charges balance based on integrating PTP scoresfor each of the one or more visit charges of the batch of open charges.

Example 117

The method of Example 115, further comprising: generating a guarantorgroup identifier based on the PTP score; and providing the guarantorgroup identifier to the first billing system.

Example 118

The method of Example 93, wherein the PTP metric comprises a guarantorgroup identifier.

Example 119

The method of Example 93, further comprising: receiving demographic datapertaining to the guarantor from one or more third-party demographicsdata sources and consumer data sources; calculating the PTP metric forthe guarantor based on both the PTP characteristics and the demographicsdata.

Example 120

The method of Example 93, further comprising determining a current stageof the guarantor's account, wherein the PTP metric for the guarantor iscalculated further based on the current stage of the guarantor'saccount.

Example 121

The method of Example 120, wherein determining a current stage of theguarantor's account comprises: detecting a staging event regarding theguarantor's account; and designating a stage of the guarantor's accountin response to detecting the staging event.

Example 122

The method of Example 93, further comprising: providing the PTP metricto the first billing system; updating the PTP metric based on asubsequent healthcare data pertaining to one or more subsequenthealthcare visits; and providing an updated PTP metric to the firstbilling system.

Example 123

A computer-implemented method for managing payments to a provider, themethod comprising: aggregating, at a payment management systemcomprising one or more computing devices, historical transaction datatracked in a first billing system of a provider, the historicaltransaction data pertaining to encounters of beneficiaries with theprovider, each of the beneficiaries guaranteed by a guarantor of one ormore guarantors; extracting payment characteristics from the historicaltransaction data, including payment characteristics of the one or moreguarantors; calculating a payment score for a first guarantor of the oneor more guarantors based on payment characteristics of the firstguarantor extracted from the historical transaction data, the paymentscore summarizing a predication that the first guarantor is going to payfor charges for encounters.

Example 124

The method of Example 123, wherein the payment score comprises apropensity-to-pay (PTP) score providing indication of a likelihood thatthe first guarantor will pay for charges for encounters.

Example 125

The method of Example 123, wherein the payment score comprises anability-to-pay (ATP) score providing indication of a capacity of thefirst guarantor to pay for charges for encounters.

Example 126

The method of Example 123, wherein the encounters comprise visits to ahealthcare provider for healthcare services.

Example 127

The method of Example 123, wherein the encounters comprise encounters topurchase products from a provider.

Example 128

The method of Example 123, wherein the historical transaction dataincludes billing transaction records, payment transaction records,and/or financing plan records associated with charges of an encounter ofa beneficiary who is associated with the first guarantor.

Example 129

The method of Example 128, wherein the beneficiary is the firstguarantor.

Example 130

A system for managing payments for services, comprising: one or moreprocessors; a memory in electrical communication with the one or moreprocessors to store first visit data specifying a first visit chargepertaining to a first visit for which a first guarantor is responsibleand to store second visit data specifying a second visit chargepertaining to a second visit for which a second guarantor isresponsible, wherein the first visit data is tracked in a first billingsystem; a linking engine to receive a request to link an account of thefirst guarantor to the account of the second guarantor, provide anelectronic notice of the request, receive indication of acceptance ofthe request, and to link the account of the first guarantor to theaccount of the second guarantor; a visits engine to aggregate the firstvisit data pertaining to the first visit charge with the second visitdata pertaining to an account of the second guarantor; a statementengine to provide to the second guarantor an electronic statementincluding information from the first visit data pertaining to the firstvisit charge of the first guarantor aggregated with information from thesecond visit data pertaining to the second visit charge of the secondguarantor.

Example 131

The system of Example 130, wherein the second visit data is tracked inthe first billing system.

Example 132

The system of Example 130, wherein the second visit data is receivedfrom and tracked in a second billing system on one or more computersremote from the payment management system and coupled to the paymentmanagement system over a network.

Example 133

The system of Example 130, further comprising a payment clearance androuting engine to receive payment data specifying a payment vehicle forpaying a payment amount, communicate one or more transaction requests toprocess an electronic financial transaction to obtain payment funds inthe payment amount from a payor financial institution associated withthe payment vehicle and to transfer a first portion of the payment fundsto a payee financial institution associated with associated with aprovider of the first visit, and communicate one or more electronicposting files to notify the account of the first guarantor of transferof the first portion of the payment funds toward payment of the chargefor the first visit.

Example 134

The system of Example 130, wherein the linking engine automaticallyrequests from each of the first guarantor and the second guarantor adigitally signed release in compliance with externally imposed rules toprotect information, wherein the linking engine receives the digitallysigned release of each of the first guarantor and the second guarantorprior to the statement engine providing to the second guarantorinformation from the first visit data pertaining to the first visitcharge.

Example 135

The system of Example 134, wherein the externally imposed rules toprotect information comprise the Health Insurance Portability andAccountability Act.

Example 136

The system of Example 130, wherein the linking engine is furtherconfigured to receiving a request from one of the first guarantor andthe second guarantor to unlink the account of the first guarantor fromthe account of the second guarantor, such that the second guarantorceases to manage the account of the first guarantor on the paymentmanagement system, and unlink the account of the first guarantor fromthe account of the second guarantor, including removing from informationpertaining to an account of the second guarantor information from thefirst visit data pertaining to the first visit charge, wherein thestatement engine, upon the unlinking, provides to the second guarantorinformation pertaining to an account of the second guarantor on thepayment management system, without information from the first visit datapertaining to the first visit charge.

Example 137

The system of Example 136, wherein unlinking the account of the firstguarantor from the account of the second guarantor comprises maintainingin the account of the second guarantor information pertaining topayments initiated by the second guarantor toward visit charges of thefirst guarantor.

Example 138

A computer-implemented method for managing payments for services, themethod comprising: receiving, at a payment management system comprisingone or more computing devices, first visit data including a first visitcharge pertaining to a first visit for which a first guarantor isresponsible, the first visit charge including one or more chargesincurred during the first visit; tracking the first visit charge in anaccount of the first guarantor on the payment management system;receiving at the payment management system a request of the firstguarantor for a second guarantor to manage the account of the firstguarantor on the payment management system; generating an electronicnotice to the second guarantor of the request of the first guarantor;receiving at the payment management system an electronic indication ofthe second guarantor's acceptance of the request of the first guarantor;making the second guarantor a manager of the account of the firstguarantor, based on the received indication of the second guarantor'sacceptance, by linking the account of the first guarantor to the accountof the second guarantor; and providing to the second guarantorinformation from the first visit data pertaining to the first visitcharge, including an amount of the first visit charge, aggregated withinformation pertaining to an account of the second guarantor on thepayment management system.

Example 139

The method of Example 138, wherein the first visit data is tracked in afirst billing system associated with a provider of the first visit.

Example 140

The method of Example 139, wherein the first billing system is separatefrom the payment management system and the account of the firstguarantor is tracked separately from tracking of the first visit data inthe first billing system.

Example 141

The method of Example 139, wherein the first billing system is on theone or more computing devices of the payment management system.

Example 142

The method of Example 138, further comprising: populating the account ofthe first guarantor and the account of the second guarantor withinformation pertaining to the request of the first guarantor.

Example 143

The method of Example 142, further comprising: providing to a computingdevice of the first guarantor information pertaining to the account ofthe first guarantor, including information pertaining to the request ofthe first guarantor.

Example 144

The method of Example 142, further comprising: providing to a computingdevice of the second guarantor information pertaining to the account ofthe second guarantor, including information pertaining to the request ofthe first guarantor.

Example 145

The method of Example 138, further comprising: receiving, at the paymentmanagement system, second visit data including a second visit chargepertaining to a second visit for which the second guarantor isresponsible; and tracking the second visit charge in the account of thesecond guarantor on the payment management system, wherein theinformation provided to the second guarantor also includes informationfrom the first visit data pertaining to the second visit charge,including an amount of the second visit charge.

Example 146

The method of Example 145, wherein the first visit data and the secondvisit data are tracked in a first billing system associated with aprovider of the first visit and a provider of the second visit.

Example 147

The method of Example 145, wherein the second visit data is tracked in asecond billing system separate from the payment management system andthe account of the second guarantor is tracked separately from trackingof the account of the second guarantor on the payment management system.

Example 148

The method of Example 147, wherein the second billing system is remotefrom the one or more computing devices of the payment management systemand coupled to the payment management system over a network.

Example 149

The method of Example 145, further comprising: receiving, from acomputing device of the second guarantor, input from the secondguarantor pertaining to payment of the first visit charge and payment ofthe second visit charge.

Example 150

The method of Example 138, further comprising: receiving, from acomputing device of the second guarantor, input from the secondguarantor pertaining to payment of the first visit charge.

Example 151

The method of Example 138, wherein the first visit data includes asecond visit charge pertaining to a second visit for which the firstguarantor is responsible, the method further comprising: providing tothe second guarantor information pertaining to the second visit charge,including an amount of the second visit charge with the information fromthe first visit data and the information pertaining to an account of thesecond guarantor; and receiving from a computing device of the secondguarantor input from the second guarantor pertaining to payment for thesecond visit charge.

Example 152

The method of Example 138, wherein the request of the first guarantorfor the second guarantor to manage the account of the first guarantorincludes authorization for the second guarantor to receive and view theaccount information of the first guarantor.

Example 153

The method of Example 138, further comprising: receiving at the paymentmanagement system a request from one of the first guarantor and thesecond guarantor to unlink the account of the first guarantor from theaccount of the second guarantor, such that the second guarantor ceasesto manage the account of the first guarantor on the payment managementsystem; unlinking the account of the first guarantor from the account ofthe second guarantor, including removing from information pertaining toan account of the second guarantor information from the first visit datapertaining to the first visit charge; and providing to the secondguarantor information pertaining to an account of the second guarantoron the payment management system, without information from the firstvisit data pertaining to the first visit charge.

Example 154

The method of Example 153, wherein unlinking the account of the firstguarantor from the account of the second guarantor comprises maintainingin the account of the second guarantor information pertaining topayments initiated by the second guarantor toward visit charges of thefirst guarantor.

Example 155

The method of Example 138, further comprising: receiving at the paymentmanagement system payment data specifying a payment vehicle for paying apayment amount; communicating one or more transaction requests toprocess an electronic financial transaction to obtain payment funds inthe payment amount from a payor financial institution associated withthe payment vehicle and to transfer a first portion of the payment fundsto a payee financial institution associated with associated with aprovider of the first visit; and communicating one or more electronicposting files to notify the account of the first guarantor of transferof the first portion of the payment funds toward payment of the chargefor the first visit and to notify.

Example 156

The method of Example 155, wherein the transaction request is further toprocess an electronic transaction to transfer a second portion of thepayment funds to a payee financial institution associated with a secondbilling system, and wherein the one or more electronic posting files arefurther to notify the second billing system of transfer of the secondportion of the payment funds toward payment of the charge for the secondvisit.

Example 156

The method of Example 138, wherein making the second guarantor a managerof the account of the first guarantor comprises: automaticallyrequesting from each of the first guarantor and the second guarantor adigitally signed release in compliance with externally imposed rules toprotect information; and receiving the digitally signed release of eachof the first guarantor and the second guarantor, prior to providing tothe second guarantor information from the first visit data pertaining tothe first visit charge.

Example 157

The method of Example 156, wherein the externally imposed rules toprotect information comprise the Health Insurance Portability andAccountability Act.

Example 158

A computer-implemented method for managing payments for services, themethod comprising: receiving, at a payment management system comprisingone or more computing devices, first visit data including a first visitcharge pertaining to a first visit for which a first guarantor isresponsible, the first visit charge including one or more chargesincurred during the first visit; tracking the first visit charge in anaccount of the first guarantor on the payment management system;receiving at the payment management system a request of a secondguarantor to manage an account of the first guarantor on the paymentmanagement system; generating an electronic notice to the firstguarantor of the request of the second guarantor; receiving at thepayment management system an electronic indication of the firstguarantor's acceptance of the request of the second guarantor; makingthe second guarantor a manager of the account of the first guarantor,based on the received indication of the first guarantor's acceptance, bylinking the account of the first guarantor to the account of the secondguarantor; and providing to the second guarantor information from thefirst visit data pertaining to the first visit charge, including anamount of the first visit charge, aggregated with information pertainingto an account of the second guarantor on the payment management system.

Example 159

The method of Example 158, the further comprising: receiving, at thepayment management system, second visit data including a second visitcharge pertaining to a second visit for which the second guarantor isresponsible; and tracking the second visit charge in the account of thesecond guarantor on the payment management system, wherein theinformation provided to the second guarantor also includes informationfrom the first visit data pertaining to the second visit charge,including an amount of the second visit charge.

Example 160

The method of Example 159, wherein the first visit data and the secondvisit data are tracked in a first billing system associated with aprovider of the first visit and a provider of the second visit.

Example 161

The method of Example 159, wherein the second visit data is tracked in asecond billing system separate from the payment management system andthe account of the second guarantor is tracked separately from trackingof the account of the second guarantor on the payment management system.

Example 162

A system for managing payments for services, comprising: one or moreprocessors; a memory in electrical communication with the one or moreprocessors to store first visit data received from a first billingsystem and second visit data that is tracked by a second billing systemthat is independent from the first billing system, the first visit dataspecifying a charge for a first visit, and the second visit dataspecifying a charge for a second visit; a visits engine to aggregate thefirst visit data pertaining to the first visit charge with the secondvisit data pertaining to the second visit charge; a statement engine toprovide a statement including information from the first visit datapertaining to the first visit charge aggregated with information fromthe second visit data pertaining to the second visit charge.

Example 163

The system of Example 162, further comprising: a payment portal toreceive payment data specifying a payment vehicle for paying a paymentamount; and a payment and clearance routing engine to: transmit atransaction request to a payment gateway to request the payment gatewayto obtain funds in the payment amount from a payor financial institutionassociated with the payment vehicle, to transfer a first portion of thepayment funds to a payee financial institution associated with the firstpatient billing system, and to transfer a second portion of the paymentfunds to a payee financial institution associated with the secondpatient billing system; and communicate one or more electronic postingfiles to notify the first patient billing system of transfer of thefirst portion of the payment funds toward payment of the charge for thefirst visit and to notify the second patient billing system of transferof the second portion of the payment funds toward payment of the chargefor the second visit.

Example 164

The system of Example 162, further comprising an extraction engine toextract the first visit data from the first billing system and togenerate a single longitudinal portrayal including the first visit dataand the second visit data.

Example 165

The system of Example 162, wherein the visits engine is further tocompile the first visit charge and the second visit charge into acurrent batch of open charges and generate an open charges balance byaggregating all open charges of the current batch of open charges, thesystem further comprising: a balance brokering engine to evaluate theopen charges balance based on asset sales criteria for determiningwhether the open charges balance should be transferred from the firstbilling system to a new system of record and effectuate electronictransactions to transfer title of an accounts receivable asset thatconstitutes rights to collect payment for the open charges balance,including payment for the current batch of open charges, to the newsystem of record, if the asset sales criteria are met; and wherein thesystem tracks the open charges balance, including payments to pay theone or more visit charges and other transactions relating to the opencharges balance, wherein the system tracks the open charges balanceseparate from the first billing system and tracks transactions trackedin the first billing system that pertain to the one or more visitcharges.

Example 166

The system of Example 165, further comprising: a scoring engineconfigured to extract propensity-to-pay (“PTP”) characteristics from thefirst visit data and the second visit data, including PTPcharacteristics of the one or more guarantors, and calculate a PTPmetric for a guarantor based on PTP characteristics of the guarantorextracted from the historical healthcare data, wherein the PTP metricindicates a likelihood that the guarantor will pay for visit charges forhealthcare visits, wherein the PTP metric is one of the asset salescriteria upon which the balance brokering engine evaluates the opencharges balance.

Example 167

The system of Example 162, further comprising: a financing engine to:present, to a guarantor of both the charge for the first visit and thecharge for the second visit, pre-determined payment options for payingan open charges balance including the charge for the first visit and thecharge for the second visit, each of the pre-determined payment optionsincluding terms at least partially defined by one of a present assetholder and a potential asset holder of the open charges balance;receive, at the payment management system, a guarantor selection of oneof the pre-determined payment options for paying the open chargesbalance; and determine a payment amount based on the selected one of thepre-determined payment options.

Example 168

A computer-implemented method for managing payments for services, themethod comprising: receiving at one or more computing devices firstvisit data from a first billing system, the first visit data including acharge for a first visit; receiving at the one or more computing devicessecond visit data being tracked in a second billing system that isindependent from the first billing system, the second visit dataspecifying a charge for a second visit; receiving at the one or morecomputing devices payment data specifying a payment vehicle for paying apayment amount; communicating a transaction request to a payment gatewayto request the payment gateway process an electronic financialtransaction to obtain payment funds in the payment amount from a payorfinancial institution associated with the payment vehicle, to transfer afirst portion of the payment funds to a payee financial institutionassociated with the first patient billing system, and to transfer asecond portion of the payment funds to a payee financial institutionassociated with the second patient billing system; and communicating oneor more electronic posting files to notify the first billing system oftransfer of the first portion of the payment funds toward payment of thecharge for the first visit and to notify the second billing system oftransfer of the second portion of the payment funds toward payment ofthe charge for the second visit.

Example 169

The method of Example 168, further comprising generating on the one ormore computing devices an open charges balance by summing the charge forthe first visit and the charge for the second visit to aggregate chargesduring a given time period and that are tracked in multiple billingsystems.

Example 170

The method of Example 168, wherein the payment gateway is a remote thirdparty gateway coupled to the one or more computers by a network, whereincommunicating a transaction request to the payment gateway comprisestransmitting the transaction request over the network.

Example 171

The method of Example 168, wherein the payment amount differs from thecharge for the first visit and differs from the amount of the charge forthe second healthcare visit.

Example 172

The method of Example 168, further comprising: receiving at the one ormore computing devices payment option input specifying present oreventual asset holder pre-determined payment options; and receiving atthe one or more computing devices a selection of one of the providerpre-determined payment options; and determining the payment amount basedon the selected one of the provider pre-determined payment options.

Example 173

The method of claim Example 172, wherein the payment options inputincludes a pay-in-full discount.

Example 174

The method of Example 172, wherein the payment options input includesprovider-determined preset financing terms.

Example 175

The method of Example 172, wherein the payment options input includesprovider-determined parameters for guarantor-customized financing terms.

Example 176

The method of Example 168, further comprising generating a singlelongitudinal portrayal of visit data including the first visit data andthe second visit data.

Example 177

The method of Example 176, further comprising providing the longitudinalportrayal to a client computing device over a network.

Example 178

The method of Example 168, wherein the first visit data specifies acharge for a first visit of a beneficiary and the second visit dataspecifies a charge for a second visit of the beneficiary.

Example 179

The method of Example 168, wherein the first visit data specifies acharge for a first visit of a beneficiary and the second visit dataspecifies a charge for a second visit of a second beneficiary.

Example 180

The method of Example 168, wherein the first visit is a first healthcarevisit, the second visit is a second healthcare visit, and a beneficiaryof the first healthcare visit and the second healthcare visit is apatient.

Example 181

The method of Example 168, wherein the first visit is a first healthcarevisit of a first patient and the second visit is a second healthcarevisit of a second patient.

Example 182

The method of Example 168, wherein the payment data specifies a paymentvehicle of a guarantor of a beneficiary of the first visit and abeneficiary of the second visit.

Example 183

The method of Example 182, wherein the guarantor is the beneficiary ofat least one of the first visit and the second visit.

Example 184

The method of Example 168, wherein the second visit data is receivedfrom the second billing system, wherein the second billing system isremote from the one or more computing devices.

Example 185

The method of Example 168, wherein the first visit data includes acharge for each of a first plurality of visits during a time period, andwherein the one or more electronic posting files to notify the firstpatient billing system of transfer of the first portion of the paymentfunds and allocates the first portion of the payment funds towardpayment of the charge of one or more of the first plurality of visits.

Example 186

The method of Example 185, further comprising receiving at the one ormore computing devices one or more payor preferences for specifying howa payment is to be allocated to among the first plurality of visitcharges; generating the one or more electronic posting files based onthe payor preferences.

Example 187

The method of Example 168, wherein the charge for the first visit istracked in an account within the first billing system and the charge forthe second visit is tracked in an account in the second billing system,wherein a first electronic posting file of the one or more electronicposting files specifies the account within the first billing system anda second electronic posting file of the one or more electronic postingfiles specifies the account within the second billing system.

Example 188

The method of Example 168, wherein the first billing system isassociated with a first balance sheet entity and the second billingsystem is associated with a second balance sheet entity that isindependent from the first balance sheet entity.

Example 189

The method of Example 168, wherein the charge for the first visitcomprises an aggregation of a plurality of line item charges for thefirst visit, such that all the line item charges for the first visitwere incurred for the first visit.

The above description provides numerous specific details for a thoroughunderstanding of the embodiments described herein. However, those ofskill in the art will recognize that one or more of the specific detailsmay be omitted, or other methods, components, or materials may be used.In some cases, operations are not shown or described in detail.

Furthermore, the described features, operations, or characteristics maybe combined in any suitable manner in one or more embodiments. It willalso be readily understood that the order of the steps or actions of themethods described in connection with the embodiments disclosed may bechanged as would be apparent to those skilled in the art. Thus, anyorder in the drawings or Detailed Description is for illustrativepurposes only and is not meant to imply a required order, unlessspecified to require an order.

Embodiments may include various steps, which may be embodied inmachine-executable instructions to be executed by a general-purpose orspecial-purpose computer (or other electronic device). Alternatively,the steps may be performed by hardware components that include specificlogic for performing the steps, or by a combination of hardware,software, and/or firmware.

Embodiments may also be provided as a computer program product includinga computer-readable storage medium having stored instructions thereonthat may be used to program a computer (or other electronic device) toperform processes described herein. The computer-readable storage mediummay include, but is not limited to: hard drives, floppy diskettes,optical disks, CD-ROMs, DVD-ROMs, ROMs, RAMs, EPROMs, EEPROMs, magneticor optical cards, solid-state memory devices, or other types ofmedia/machine-readable media suitable for storing electronicinstructions.

As used herein, a software module or component may include any type ofcomputer instruction or computer-executable code located within a memorydevice and/or computer-readable storage medium. A software module may,for instance, comprise one or more physical or logical blocks ofcomputer instructions, which may be organized as a routine, a program,an object, a component, a data structure, etc., that perform one or moretasks or implement particular abstract data types.

In certain embodiments, a particular software module may comprisedisparate instructions stored in different locations of a memory device,which together implement the described functionality of the module.Indeed, a module may comprise a single instruction or many instructions,and may be distributed over several different code segments, amongdifferent programs, and across several memory devices. Some embodimentsmay be practiced in a distributed computing environment where tasks areperformed by a remote processing device linked through a communicationsnetwork. In a distributed computing environment, software modules may belocated in local and/or remote memory storage devices. In addition, databeing tied or rendered together in a database record may be resident inthe same memory device, or across several memory devices, and may belinked together in fields of a record in a database across a network.

It will be obvious to those having skill in the art that many changesmay be made to the details of the above-described embodiments withoutdeparting from the underlying principles of the invention. The scope ofthe present invention should, therefore, be determined only by thefollowing claims.

We claim:
 1. A system for managing payments for healthcare services,comprising: one or more processors; a memory in electrical communicationwith the one or more processors, the memory to store historicalhealthcare data including healthcare transaction data tracked by a firstbilling system, the historical healthcare data pertaining to one or moreguarantors; a scoring engine configured to extract propensity-to-pay(“PTP”) characteristics from the historical healthcare data, includingPTP characteristics of the one or more guarantors, and calculate a PTPmetric for a guarantor based on PTP characteristics of the guarantorextracted from the historical healthcare data, wherein the PTP metricindicates a likelihood that the guarantor will pay for visit charges forhealthcare visits.
 2. The system of claim 1, wherein the PTP metriccomprises a PTP score.
 3. The system of claim 2, wherein the scoringengine comprises a plurality of calculation engines, each configured tocalculate a respective type of PTP score for a guarantor.
 4. The systemof claim 3, wherein the plurality of calculation engines differ withrespect to one or more of a weighting and a combination of algorithmsused to calculate a PTP score.
 5. The system of claim 1, wherein the PTPmetric is a group identifier that groups a guarantor into a group havingan associated propensity-to-pay a visit charge for a healthcare visit.6. The system of claim 1, further comprising: a staging module todetermine a current stage of an account record of the guarantor, basedon the historical healthcare data, wherein the scoring engine calculatesthe PTP metric for the guarantor based on the stage of the accountrecord of the guarantor.
 7. The system of claim 6, wherein the stagingmodule comprises a trigger engine configured to implement one or moretriggered actions in response to one or more of: assigning a stage to anaccount record; updating data pertaining to an account record; and arequest for updated stage assignment information.
 8. The system of claim1, the memory to further store first visit data that is tracked by afirst billing system and specifying one or more visit charges incurredduring a time period, each of the one or more visit charges incurred fora visit, the system further comprising: a visits engine to aggregate theone or more visit charges into a current batch of open charges andgenerate an open charges balance by aggregating all open charges of thecurrent batch of open charges, wherein the scoring engine calculates thePTP metric for the guarantor with respect to the open charges balance,such that the PTP metric indicates a likelihood that the guarantor willpay for the open charges balance.
 9. The system of claim 1, wherein thehistorical healthcare data includes healthcare transaction data trackedby a second billing system.
 10. The system of claim 1, the memoryfurther to store credit reporting data from one or more third partycredit reporting sources, wherein the scoring engine calculates the PTPmetric for the guarantor based on both the PTP characteristics and thecredit reporting data.
 11. The system of claim 10, wherein the scoringengine is configured to extract an ability-to-pay (ATP) metric from oneor more of the credit reporting data and demographic data pertaining tothe guarantor from one or more third-party demographics data sources andconsumer data sources, and wherein the scoring engine calculates the PTPmetric based on the PTP characteristics and the ATP metric.
 12. Thesystem of claim 11, further comprising: a charity evaluation moduleconfigured to calculate a charity score for a guarantor based on the PTPmetric and the ATP metric.
 13. A computer-implemented method formanaging payments for healthcare services, the method comprising:aggregating, at a payment management system comprising one or morecomputing devices, historical healthcare data including healthcaretransaction data tracked by a first billing system, the historicalhealthcare data pertaining to healthcare visits guaranteed by one ormore guarantors; extracting propensity-to-pay (“PTP”) characteristicsfrom the historical healthcare data, including PTP characteristics ofthe one or more guarantors; calculating a PTP metric for a firstguarantor of the one or more guarantors based on PTP characteristics ofthe first guarantor extracted from the historical healthcare data, thePTP metric indicating a likelihood that the first guarantor will pay forvisit charges for healthcare visits.
 14. The method of claim 13, whereinthe healthcare transaction data includes billing transaction records,payment transaction records, and/or financing plan records associatedwith an account record of one or more of the first guarantor and a firstpatient associated with the first guarantor.
 15. The method of claim 13,wherein the healthcare transaction data includes healthcare transactionaction data for a second guarantor whose account record is linked to theaccount record of the first guarantor.
 16. The method of claim 15,further comprising calculating a PTP metric for the second guarantorbased on PTP characteristics of the second guarantor extracted from thehistorical healthcare data, the PTP metric indicating a likelihood thatthe second guarantor will pay for visit charges.
 17. The method of claim13, wherein the PTP metric is calculated based on PTP characteristics ofthe first guarantor that are inferred from PTP characteristics of one ormore different guarantors of the one or more guarantors that are similarto the first guarantor.
 18. The method of claim 13, wherein thehistorical healthcare data includes healthcare transaction data trackedby a plurality of billing systems in addition to the first billingsystem.
 19. The method of claim 13, further comprising: receiving creditreporting data from one or more third-party credit reporting sources;calculating the PTP metric for the guarantor based on both the PTPcharacteristics and the credit reporting data.
 20. The method of claim13, wherein the PTP characteristics include one or more of: a time topayment for healthcare transactions; late payments; payment amounts;insurance coverage; copayments; flexible spending account activity(e.g., estimated remaining balance); healthcare spending accountactivity; financing plan history (e.g., whether the patient and/orguarantor(s) have used a financing plan to pay for services and/orwhether the payments were made in a timely manner); a total amountpresently owed to a provider; prior bad debt charge-offs; prior hardshipprogram assistance (charity); time periods between transactions; anddispute history.
 21. The method of claim 13, further comprising:receiving, at a payment management system, first visit data that istracked by a first billing system and that specifies one or more visitcharges each incurred for a visit to a healthcare provider, wherein thePTP score for the guarantor is calculated for a visit charge of the oneor more visit charges that is guaranteed by the guarantor.
 22. Themethod of claim 13, further comprising: receiving demographic datapertaining to the guarantor from one or more third-party demographicsdata sources and consumer data sources; calculating the PTP metric forthe guarantor based on both the PTP characteristics and the demographicsdata.
 23. The method of claim 13, further comprising determining acurrent stage of the guarantor's account, wherein the PTP metric for theguarantor is calculated further based on the current stage of theguarantor's account.
 24. The method of claim 13, further comprising:providing the PTP metric to the first billing system; updating the PTPmetric based on a subsequent healthcare data pertaining to one or moresubsequent healthcare visits; and providing an updated PTP metric to thefirst billing system.
 25. A computer-implemented method for managingpayments to a provider, the method comprising: aggregating, at a paymentmanagement system comprising one or more computing devices, historicaltransaction data tracked in a first billing system of a provider, thehistorical transaction data pertaining to encounters of beneficiarieswith the provider, each of the beneficiaries guaranteed by a guarantorof one or more guarantors; extracting payment characteristics from thehistorical transaction data, including payment characteristics of theone or more guarantors; calculating a payment score for a firstguarantor of the one or more guarantors based on payment characteristicsof the first guarantor extracted from the historical transaction data,the payment score summarizing a predication that the first guarantor isgoing to pay for charges for encounters.
 26. The method of claim 25,wherein the payment score comprises a propensity-to-pay (PTP) scoreproviding indication of a likelihood that the first guarantor will payfor charges for encounters.
 27. The method of claim 25, wherein thepayment score comprises an ability-to-pay (ATP) score providingindication of a capacity of the first guarantor to pay for charges forencounters.
 28. The method of claim 25, wherein the encounters comprisevisits to a healthcare provider for healthcare services.
 29. The methodof claim 25, wherein the encounters comprise encounters to purchaseproducts from a provider.
 30. The method of claim 25, wherein thehistorical transaction data includes billing transaction records,payment transaction records, and/or financing plan records associatedwith charges of an encounter of a beneficiary who is associated with thefirst guarantor.